Science.gov

Sample records for levator labii superioris

  1. Disgust, but not anger provocation, enhances levator labii superioris activity during exposure to moral transgressions.

    PubMed

    Whitton, Alexis E; Henry, Julie D; Rendell, Peter G; Grisham, Jessica R

    2014-02-01

    Physical disgust is elicited by, and amplifies responses to, moral transgressions, suggesting that moral disgust may be a biologically expanded form of physical disgust. However, there is limited research comparing the effects of physical disgust to that of other emotions like anger, making it difficult to determine if the link between disgust and morality is unique. The current research evaluated the specificity of the relationship between disgust and morality by comparing links with anger, using state, physiological and trait measures of emotionality. Participants (N=90) were randomly allocated to have disgust, anger or no emotion induced. Responses to images depicting moral, negative non-moral, and neutral themes were then recorded using facial electromyography. Inducing disgust, but not anger, increased psychophysiological responses to moral themes. Trait disgust, but not trait anger, correlated with levator labii responses to moral themes. These findings provide strong evidence of a unique link between physical disgust and morality. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Anatomical relationships of the procerus with the nasal ala and the nasal muscles: transverse part of the nasalis and levator labii superioris alaeque nasi.

    PubMed

    Hur, Mi-Sun

    2017-08-01

    The aim of this study was to clarify the anatomical relationship of the procerus with the nose, especially focusing on the transverse part of the nasalis, the nasal ala, and the levator labii superioris alaeque nasi (LLSAN). The 53 faces from Korean cadavers were examined anatomically. The procerus originated from the superficial and deep layers in all specimens. Some fibers of the lateral part of the superficial layer extended to connect to the transverse part of the nasalis, while other such fibers extended to attach to the skin of the upper nasal ala in all specimens. The superficial and deep layers of the procerus merged and then intermingled with the frontalis. The anatomical relationship between the superficial layer of the procerus and the LLSAN was classified into the following two categories according to their connections. Some medial originating fibers of the LLSAN extended superomedially to blend in the area between the superficial layer of the procerus and the depressor supercilii (13.5%). And, some medial originating fibers of the LLSAN extended superomedially and then constituted the lateral portion of the superficial layer of the procerus (7.7%). This study has yielded crucial data for understanding the anatomical relationships and functions of the procerus in relation to the nose. They will be helpful when designing effective therapies involving botulinum toxin type A, performing various types of rhinoplasty and facial surgeries, and in electromyography analyses.

  3. Importance of the levator labii alaeque nasi muscle in dorsal septal deviations.

    PubMed

    Tellioğlu, Ali Teoman; Özakpinar, Hülda Rifat; Cakir, Bariş; Tekdemir, Ibrahim

    2011-03-01

    Deviated cartilages structures of the nose can be affected by nasal muscles, and deviation becomes conspicuous when the patient smiles. This condition depends on activity of nasal muscles, particularly the levator labii alaeque nasi muscle. A total of 124 septorhinoplasty operations were performed to correct dorsal concave septal deviation between 2005 and 2009 years. The 70 women and 54 men included in the study had an average age of 28 years. The average follow-up period was 12 months. Open septorhinoplasty was preferred in all cases. The medial part of the levator labii alaeque nasi muscle was extensively dissected from the lateral crus and surrounding tissues. The lateral crura of the alar cartilages were separated from the upper lateral cartilages in the scroll area. The dorsal septal deviation was corrected by combination of bilateral spreader grafts, which reinforced cartilage with horizontal control sutures. Early postoperative period was uneventful. Nasal obstruction was reduced after surgery, and significant subjective postoperative improvements were observed in all patients. Comparison of preoperative and postoperative photographs demonstrated improved dorsal nasal contour. Revision operation was performed in 3 cases. The corrected septal cartilage was in a good position in all revised cases; therefore, septal surgery was not performed in the revision operations. In conclusion, surgical disruption of the anatomic relationship between the muscle with the dorsal septal cartilage and reinforcement of the dorsal septal cartilage with spreader grafts and horizontal control sutures can decrease risk of recurrence.

  4. Levator Muscle Enlargement in Thyroid Eye Disease-Related Upper Eyelid Retraction.

    PubMed

    Davies, Michael J; Dolman, Peter J

    To identify levator palpebrae superioris enlargement in thyroid eye disease (TED)-related upper eyelid retraction (ULR). Retrospective case-control. Subjects included 50 consecutive patients with unilateral thyroid eye disease-related ULR ≥ 2 mm and no previous eyelid surgery. The contralateral side was used as control. Clinical information was recorded from charts. CT scans were assessed by investigators blinded to the clinical data. A prediction of retracted side was made based on CT scan appearance and on basis of measured levator palpebrae superioris cross-sectional area at 2 defined points. Statistical analysis determined correlation between levator palpebrae superioris size and presence of ULR. The study was approved by the institutional ethics committee. Side with ULR predicted from CT scan review in over 85% of cases. Mean cross-sectional area of levator palpebrae superioris on retracted side was significantly larger than nonretracted side at 2 separate sites. Levator palpebrae superioris area was larger on retracted side compared with nonretracted side in over 85% of subjects. More than 30% of subjects had no enlargement of other extraocular muscles. Only 6% of patients had enlargement of the ipsilateral inferior rectus muscle. Levator palpebrae superioris enlargement from inflammation or scar is a factor in thyroid eye disease-related ULR. Upper eyelid retraction can be predicted from CT scan appearance in over 85% of cases. Ipsilateral inferior rectus enlargement is rare. Levator palpebrae superioris is the most commonly targeted muscle in thyroid eye disease.

  5. Reconstruction of upper lip muscle system by anatomy, magnetic resonance imaging, and serial histological sections.

    PubMed

    Bo, Chen; Ningbei, Yin

    2014-01-01

    Surgeons need references to undertake cleft lip repairs. We aimed to establish a three-dimensional model of upper lip muscles. We examined specimens from 2 adult cadaver heads and 8 adult cadaver lips, obtaining serial sections in the axial, sagittal, and coronal planes. Sections were stained to observe the philtrum, Cupid bow, vermilion, and nostril sill. Reconstruction was done with three-dimensional software (eg, 3D-DOCTOR, MicroMR). Parallel circular muscle fibers existed between modioli. The orbicularis oris deep layer contained fan muscle fibers inclining inward. Some ended at the anterior nasal crest. Others migrated to the depressor septum, crossed the midline, and migrated to the nasalis muscle. At the nostril floor, the depressor septum muscle bundle and ipsilateral orbicularis oris overlapped the nasalis muscle and the contralateral orbicularis oris. This construction shaped the nostril sill. The levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor crossed the nasolabial groove and migrated to the superficial orbicularis oris, entering the outer edge of the nasal alar to the upper lip near the vermilion border and philtrum ridge, shaping Cupid bow. Contralateral deep orbicularis oris muscle fibers crossed the philtrum dimple to the lateral philtrum ridge (axial plane). Superficial reticular muscle fibers of the levator labii superioris, zygomaticus minor, zygomaticus major, and orbicularis oris inserted into the medial philtrum ridge (coronal plane). They intersected to form the philtrum ridge. A three-dimensional upper lip muscular system model was established that can be referenced for cleft lip repair and lip operations.

  6. Aponeurosis of the levator palpebrae superioris in Chinese subjects

    PubMed Central

    Pan, Er; Nie, Yun-Fei; Wang, Zhen-Jun; Peng, Li-Xia; Wu, Yan-Hong; Li, Qin

    2016-01-01

    Abstract An accurate understanding of the anatomy of the levator palpebrae superioris aponeurosis (LPSA) is critical for successful blepharoplasty of aponeurotic ptosis. We investigated the macroscopic and microscopic anatomy of the LPSA. This prospective live gross anatomy study enrolled 200 adult Chinese patients with bilateral mild ptosis undergoing elective blepharoplasty. Full-thick eyelid tissues and sagittal sections from the eyelid skin to the conjunctiva were examined with Masson trichrome staining or antismooth muscle actin (SMA) immunohistochemistry. Gross anatomy showed that the space between the superficial and deep layers of the LPSA could be accessed after incising the overlying superficial fascia, by retracting the white line. Adipose layers were clearly observed in 195 out of 200 patients with bilateral mild ptosis, among which 180 cases had the superficial layer connected to the uncoated adipose. Fifteen cases had the superficial layer connected to the smoothly coated layer, and 5 cases had the superficial layer directly connected to the deep loose fiber, almost without adipose. In previously untreated patients, the LPSA space was located beneath the intact orbital septum. In those with previous surgeries, it was beneath the superficial layer of the LPSA, underlying the destructed orbital septum. Cadaveric histology showed that the deep layer of the LPSA extended into the anterior layer of the tarsal plate and the superficial layer reflexed upward in continuity with the vertical orbital septum. An occult space existed between the 2 layers of the LPSA, with a smooth lining on the deep layer. The superficial layer of the LPSA was SMA-immunonegative but the deep layer was slightly immunopositive for SMA. An occult anatomic space exists between the superficial and deep layers of the LPSA, in proximity to the superior tarsal plate margin. Recognition of the more anatomically significant LPSA deep layer may help improve the aesthetic outcome of

  7. Muscle tension line concept in nasolabial muscle complex--based on 3-dimensional reconstruction of nasolabial muscle fibers.

    PubMed

    Yin, Ningbei; Wu, Jiajun; Chen, Bo; Song, Tao; Ma, Hengyuan; Zhao, Zhenmin; Wang, Yongqian; Li, Haidong; Wu, Di

    2015-03-01

    Plastic surgeons have attempted various ways to rebuild the aesthetic subunits of the upper lip in patients with cleft lip with less than perfect results in most cases. We propose that repairing the 3 muscle tension line groups in the nasolabial complex will have improved aesthetic results. Micro-computed tomographic scans were performed on the nasolabial tissues of 5 normal aborted fetuses and used to construct a 3-dimensional model to study the nasolabial muscle complex structure. The micro-computed tomographic (CT) scans showed the close relationship and interaction between the muscle fibers of nasalis, pars peripheralis, levator labii superioris, and pars marginalis. Based on the 2-dimensional images obtained from the micro-computed tomographic scans, we suggest the concept of nasolabial muscle complex and muscle tension line group theory: there is a close relationship among the alar part of the nasalis, depressor septi muscle, orbicularis oris muscle, and levator labii superioris alaeque nasi. The tension line groups are 3 tension line structures in the nasolabial muscle complex that interlock with each other at the intersections and maintain the specific shape and aesthetics of the lip and nose.

  8. The Aesthetic Analyzing of Midface Ratio After Folding Aponeurosis of Levator Palpebrae Superioris Muscle in the Ptosis Correction.

    PubMed

    Ji, Chenyang; Li, Ruiting; He, Wei; Zhang, Jinming

    2018-03-01

    Some fordless-eyelid patients with moderate upper lid ptosis characterize in a higher eyebrow position which leads to an increased midfacial ratio. Apart from performing blepharoplasty to create dynamic folds, additional procedures such as folding aponeurosis of levator palpebrae superioris muscle were effective to revise the enlarged ratio of midface through lowering eyebrow, which gains good aesthetic results. However, the specific changes in the proportion of facial aesthetics and the importance of these change were serious lack in the literature as far as the authors know. To measure the ratio of the length between upper edge of eyebrow and edge of lower eyelid (L1)/the length between edge of lower eyelid and nasal base (L2) in the fordless-eyelid and upper lid ptosis patients who received levator aponeurosis folding surgery, and to analyze the change in the proportion of midfacial aesthetics. From December 2015 to October 2016, the pre- and postoperative photographs from 21 cases of patients with foldless eyelid and upper lid ptosis who underwent the levator aponeurosis folding procedures in the authors' department were collected as study group. Additional full-face pictures of 20 Chinese female movie stars were prepared as control group. The ratios of L1/ L2 (J) were measured via Adobe Photoshop CS6. The statistical significance was analyzed and the change of midfacial proportion was evaluated. In the study group, the mean value of preoperative L1/L2 (J1) is 0.746, and (J2) 0.657 postoperatively. In the control group, the mean value of L1/L2 (J3) is 0.667. Statistical differences showed between the pre- and postoperative samples and between preoperative samples and control group. There was no statistical difference between postoperative samples and control group samples. The ratios between L1 and L2 in postoperative samples are close to those in the control group, which are closer to the golden radio. Levator aponeurosis folding can effectively lower eyebrow

  9. Unattractive infant faces elicit negative affect from adults

    PubMed Central

    Schein, Stevie S.; Langlois, Judith H.

    2015-01-01

    We examined the relationship between infant attractiveness and adult affect by investigating whether differing levels of infant facial attractiveness elicit facial muscle movement correlated with positive and negative affect from adults (N = 87) using electromyography. Unattractive infant faces evoked significantly more corrugator supercilii and levator labii superioris movement (physiological correlates of negative affect) than attractive infant faces. These results suggest that unattractive infants may be at risk for negative affective responses from adults, though the relationship between those responses and caregiving behavior remains elusive. PMID:25658199

  10. Functional anatomy of the levator palpebrae superioris muscle and its connective tissue system.

    PubMed Central

    Ettl, A; Priglinger, S; Kramer, J; Koornneef, L

    1996-01-01

    AIMS/BACKGROUND: The connective tissue system of the levator palpebrae superioris muscle (LPS) consists of the septa surrounding its muscle sheath, the superior transverse ligament (STL) commonly referred to as 'Whitnall's ligament' and the common sheath which is the fascia between the LPS and the superior rectus muscle (SRM). The anterior band-like component of the common sheath is called transverse superior fascial expansion (TSFE) of the SRM and LPS. It mainly extends from the connective tissue of the trochlea to the fascia of the lacrimal gland. A detailed description of the relation between the LPS and its connective tissue is presented. Furthermore, the course of the LPS in the orbit is described. The study was conducted to provide a morphological basis for biomechanical and clinical considerations regarding ptosis surgery. METHODS: Postmortem dissections were performed in 16 orbits from eight cadavers. The microscopical anatomy was demonstrated in six formalin preserved orbits from six cadavers which had been sectioned in the frontal and sagittal plane and stained with haematoxylin and azophloxin. Surface coil magnetic resonance imaging in the sagittal and coronal plane was performed in five orbits from five normal volunteers using a T1 weighted spin echo sequence. RESULTS: The STL and the TSFE surround the LPS to form a fascial sleeve around the muscle which has attachments to the medial and lateral orbital wall. The TSFE, which is thicker than the STL, blends with Tenon's capsule. The STL and the fascial sheath of the LPS muscle are suspended from the orbital roof by a framework of radial connective tissue septa. MR images show that the TSFE is located between the anterior third of the superior rectus muscle and the segment of the LPS muscle where it changes its course from upwards to downwards. In this area, the LPS reaches its highest point in the orbit (culmination point). The culmination point is located a few millimetres posterior to the equator and

  11. Numerical Correlation of Levator Advancement in Preoperative Planning.

    PubMed

    Makeeva, Valeria; Collawn, Sherry S; Pierce, Evelina N; Mousa, Mina S; Yang, Jennifer H; Davison, Peter N; Jospitre, Elodie C

    2017-06-01

    Several procedures have been proposed for the treatment of eyelid ptosis, and both levator advancement and levator plication are widely used to shorten the levator palpebrae superioris. The purpose of this study was to quantify perioperative lid measurements in patients undergoing bilateral levator aponeurosis advancements to aid in preoperative planning. Between July 2014 and June 2016, the authors performed a retrospective analysis of all bilateral upper eyelid levator advancement procedures for ptosis performed by the senior surgeon. There are a total of 21 patients (6 men and 15 women) with a mean age of 63 years (range, 48-79 years). The average time at follow-up was 5.3 months, with a range of 1 to 26 months. In this retrospective study, we collected data on presurgical measurements including marginal reflex distance 1 (MRD1), surgical technique used (symmetrical/asymmetrical levator advancement) with millimeters of advancement used, and postsurgical measurements. We found that on average, an advancement of 4 mm led to an improvement in MRD1 of 2.26 mm (n = 14), and advancement of 5 mm led to an improvement in MRD1 of 2.74 mm (n = 15). Patients also reported improvements in their quality of life. Our results may be used to guide clinicians in preoperative planning.

  12. Unattractive infant faces elicit negative affect from adults.

    PubMed

    Schein, Stevie S; Langlois, Judith H

    2015-02-01

    We examined the relationship between infant attractiveness and adult affect by investigating whether differing levels of infant facial attractiveness elicit facial muscle movement correlated with positive and negative affect from adults (N=87) using electromyography. Unattractive infant faces evoked significantly more corrugator supercilii and levator labii superioris movement (physiological correlates of negative affect) than attractive infant faces. These results suggest that unattractive infants may be at risk for negative affective responses from adults, though the relationship between those responses and caregiving behavior remains elusive. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Exogenous skeletal muscle satellite cells promote the repair of levator palpebrae superioris mechanical damage in rat.

    PubMed

    Ye, Lin; Yao, Yuanyuan; Guo, Hui; Peng, Yun

    2018-05-17

    Blepharoptosis is a drooping of the upper eyelid, usually due to dysfunction of the levator palpebrae superioris (LPS). Recently, skeletal muscle satellite cells (SSCs) have been reported to promote the repair of damaged skeletal muscle. This study aims to investigate the potential contribution of exogenous SSCs to the regeneration of mechanically damaged LPS. Thirty-two rats were randomly divided into four groups, including control group, SSCs-treated group, SSCs-treated injury group and non-treated injury group. After rats in injury groups were artificially lacerated on both the left and right LPS, HBBS (Hank's Balanced Salt Solution) containing SSCs was injected into upper eyelid tissue. After 7 days, the LPS muscle tissues were excised. In addition, skeletal muscle cells (SMCs) and SSCs were cocultured for use as an in vitro model, and the protective effects of SSCs on cultured SMCs were also investigated. Histological staining revealed that exogenous SSCs repaired the damaged muscle fibers and attenuated the fibrosis of LPS, possibly due to the increased level of IGF-1. In contrast, the level of IL-1β, IL-6, TGF-β1 and Smad2/3 (phospho-T8) were significantly reduced in the SSCs-treated group. The in vitro model using coculture of skeletal muscle cells (SMCs) and SSCs also revealed an increased level of IGF-1 and reduced level of inflammatory factors, resulting in a better cell survival rate. This study found that exogenous SSCs can promote the repair of LPS mechanical damage and provides new insight into the development of novel therapeutic approaches for blepharoptosis.

  14. Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction.

    PubMed

    Djordjević, Boban; Novaković, Marijan; Milisavljević, Milan; Milićević, Sasa; Maliković, Aleksandar

    2013-12-01

    The detailed knowledge of the architecture of the upper eyelid is very important in numerous upper eyelid corrective surgeries. The article deals with the detailed anatomy of the major components of the upper lid, which are commonly seen in surgical practice. This study was conducted on 19 human cadavers (12 adults and 7 infants) without pathologic changes in the orbital region and eyelids. Anatomic microdissection of the contents of the orbita was performed bilaterally on 12 orbits from 6 unfixed cadavers (3 male and 3 female). Micromorphologic investigations of the orbital tissue were performed on 8 en bloc excised and formalin-fixed orbits of infant cadavers. Specimens were fixed according to the Duvernoy method. An intra-arterial injection of 5% mixture of melt formalin and black ink was administered into the carotid arterial system. Using routine fixation, decalcination, dehydration, illumination, impregnation and molding procedures in paraplast, specimens were prepared for cross-sections. The measurement of the muscle length and diameter in situ in 6 nonfixed cadavers (12 orbits) showed an average length of the levator palpbrae superioris (LPS) muscle body of the 42.0 +/- 1.41 mm on the right, and 40.3 +/- 1.63 mm on the left side. In all the cases, the LPS had blood supply from 4 different arterial systems: the lacrimal, supratrochlear, and supraorbital artery and muscle branches of the ophthalmic artery. The LPS muscle in all the specimens was supplied by the superior medial branch of the oculomotor nerve. The connective tissue associated with the LPS muscle contains two transverse ligaments: the superior (Whitnall's) and intermuscular transverse ligaments (ITL). The orbital septum in all the specimens originated from the arcus marginalis of the frontal bone, and consisted of two layers--the superficial and the inner layer. In addition, a detailed histological analysis revealed that the upper eyelid's crease was formed by the conjoined fascia including the

  15. On the origin, homologies and evolution of primate facial muscles, with a particular focus on hominoids and a suggested unifying nomenclature for the facial muscles of the Mammalia

    PubMed Central

    Diogo, R; Wood, B A; Aziz, M A; Burrows, A

    2009-01-01

    The mammalian facial muscles are a subgroup of hyoid muscles (i.e. muscles innervated by cranial nerve VII). They are usually attached to freely movable skin and are responsible for facial expressions. In this study we provide an account of the origin, homologies and evolution of the primate facial muscles, based on dissections of various primate and non-primate taxa and a review of the literature. We provide data not previously reported, including photographs showing in detail the facial muscles of primates such as gibbons and orangutans. We show that the facial muscles usually present in strepsirhines are basically the same muscles that are present in non-primate mammals such as tree-shrews. The exceptions are that strepsirhines often have a muscle that is usually not differentiated in tree-shrews, the depressor supercilii, and lack two muscles that are usually differentiated in these mammals, the zygomatico-orbicularis and sphincter colli superficialis. Monkeys such as macaques usually lack two muscles that are often present in strepsirhines, the sphincter colli profundus and mandibulo-auricularis, but have some muscles that are usually absent as distinct structures in non-anthropoid primates, e.g. the levator labii superioris alaeque nasi, levator labii superioris, nasalis, depressor septi nasi, depressor anguli oris and depressor labii inferioris. In turn, macaques typically lack a risorius, auricularis anterior and temporoparietalis, which are found in hominoids such as humans, but have muscles that are usually not differentiated in members of some hominoid taxa, e.g. the platysma cervicale (usually not differentiated in orangutans, panins and humans) and auricularis posterior (usually not differentiated in orangutans). Based on our observations, comparisons and review of the literature, we propose a unifying, coherent nomenclature for the facial muscles of the Mammalia as a whole and provide a list of more than 300 synonyms that have been used in the

  16. A Practice Indexes for Improving Facial Movements of Brass Instrument Players

    NASA Astrophysics Data System (ADS)

    Ito, Kyoko; Hirano, Takeshi; Noto, Kazufumi; Nishida, Shogo; Ohtsuki, Tatsuyuki

    Two experimental studies have been conducted in order to propose practice indexes for the improvement of the embouchure of French horn players, two experimental studies have been conducted. In both studies, the same task was performed by advanced and amateur French horn players. The first study investigated the activity, while performing the above-mentioned task, of the 5 facial muscles (levator labii superioris, zygomaticus major, depressor anguli oris, depressor labii inferioris, and risorius muscles) on the right side of the face by surface electromyography, and the facial movement on the left side of the face by attaching two markers above each muscle and using two high-speed cameras simultaneously. The results of the study showed that it is possible for the four markers around the lower lip to practice indexes. The second study evaluated whether the above-mentioned markers are appropriate as practice indexes using a 3-D tracking system and questionnaires. The results showed that both the advanced and the amateur players assessed that the markers were suitable as practice indexes for improving the embouchure. This set of approaches could be useful for selecting practice indexes and developing scientific practice methods not only for the French horn but also for other instruments and other fields.

  17. Botulinum Toxin for the Treatment of Excessive Gingival Display: A Systematic Review.

    PubMed

    Nasr, Marwan W; Jabbour, Samer F; Sidaoui, Joseph A; Haber, Roger N; Kechichian, Elio G

    2016-01-01

    To date, no standardized minimally invasive approach for the treatment of excessive gingival display exists. This systematic review aims to assess the evidence in the literature regarding the role of botulinum toxin injection in the management of gummy smile. All publications through December 2014 and pertaining to the subject were electronically searched in PubMed, Embase, Scopus, and Web of Science, and the bibliographies of retrieved articles were manually screened. Out of 33 articles, 29 were discarded based on exclusion criteria. Although all 4 selected articles were in line with a role for botulinum toxin injection in the treatment of gummy smiles and the importance of targeting the levator labii superioris alaeque nasi muscle, studies differed in the type and the dose of toxin administered and the technique adopted. Injection with botulinum toxin is a novel, safe, and cosmetically effective treatment for gummy smile when performed by experienced practitioners. However, further randomized controlled trials are warranted. LEVEL OF EVIDENCE 4: Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  18. Location of the levator veli palatini insertion following levator retropositioning, palatal pushback, and pharyngeal flap procedures.

    PubMed

    Mulliken, J B; Giargiana, F A; Claybaugh, G J; Hoopes, J E

    1975-07-01

    A long-term cineradiographic follow-up study of twenty patients with velo-pharyngeal incompetence fails to demonstrate predictable retrodisplacement of the levator insertion following combined levator retropositioning, pushback, and pharyngeal flap procedures. Simple levator retropositioning gave posterior displacement in the two patients evaluated. Patients with normal or posterior levator insertions pre-operatively all demonstrated post-operative anterior displacement following pharyngeal flap procedures, either alone or in combination with pushback. Anterior levator displacement may be the result of scar contraction or division of the levator sling (during insetting of a pharyngeal flap). Pre-operative and post-operative speech evaluation demonstrated substantial improvement in all except 3 patients; 2 of the poor speech results were patients with demonstrated levator retrodisplacement on post-operative cineradiography.

  19. Quantitative Magnetic Resonance Imaging Volumetry of Facial Muscles in Healthy Patients with Facial Palsy

    PubMed Central

    Volk, Gerd F.; Karamyan, Inna; Klingner, Carsten M.; Reichenbach, Jürgen R.

    2014-01-01

    Background: Magnetic resonance imaging (MRI) has not yet been established systematically to detect structural muscular changes after facial nerve lesion. The purpose of this pilot study was to investigate quantitative assessment of MRI muscle volume data for facial muscles. Methods: Ten healthy subjects and 5 patients with facial palsy were recruited. Using manual or semiautomatic segmentation of 3T MRI, volume measurements were performed for the frontal, procerus, risorius, corrugator supercilii, orbicularis oculi, nasalis, zygomaticus major, zygomaticus minor, levator labii superioris, orbicularis oris, depressor anguli oris, depressor labii inferioris, and mentalis, as well as for the masseter and temporalis as masticatory muscles for control. Results: All muscles except the frontal (identification in 4/10 volunteers), procerus (4/10), risorius (6/10), and zygomaticus minor (8/10) were identified in all volunteers. Sex or age effects were not seen (all P > 0.05). There was no facial asymmetry with exception of the zygomaticus major (larger on the left side; P = 0.012). The exploratory examination of 5 patients revealed considerably smaller muscle volumes on the palsy side 2 months after facial injury. One patient with chronic palsy showed substantial muscle volume decrease, which also occurred in another patient with incomplete chronic palsy restricted to the involved facial area. Facial nerve reconstruction led to mixed results of decreased but also increased muscle volumes on the palsy side compared with the healthy side. Conclusions: First systematic quantitative MRI volume measures of 5 different clinical presentations of facial paralysis are provided. PMID:25289366

  20. Correcting the Alar Base Retraction in Crooked Nose by Dissection of Levator Alaque Nasi Muscle.

    PubMed

    Taş, Süleyman

    2016-10-01

    Nasal base retraction results from cephalic malposition of the alar base in the vertical plane causing disharmonies in the alar base. In literature, there are some excisional procedures to correct this deformity, but it may result to nostril distortion, stenosis, or upper lip elevation. Here, a new technique is reported for the correction of nasal base retraction in crooked nose by manipulating the levator labii alaeque nasi muscle. Sixteen patients, 6 women and 10 men ranging in age from 21 to 42 years, who have alar retraction with crooked nose, were operated, with a follow-up period of 12 months. Preoperative and postoperative frontal, profile, base, and oblique base views in a standard manner were taken and analyzed with Image software. Comparison of preoperative and postoperative photographs demonstrated that nasal base retractions were corrected in all cases without distortion and recurrence. Nasal obstruction was reduced after surgery, and self-evaluation of nasal patency scores significantly increased in all patients (P < 0.001). Functional and aesthetic outcomes were satisfactory for surgeons and the patients. Careful analysis to identify the deformity and proper selection of the technique will ensure a pleasing outcome. The new techniques presented for the correction of nasal base retraction and prevention of the recurrence of the dorsal deviation will help rhinoplasty surgeons obtain pleasing outcomes.

  1. Modified Lip Repositioning with Esthetic Crown Lengthening: A Combined Approach to Treating Excessive Gingival Display.

    PubMed

    Sánchez, Isis M; Gaud-Quintana, Sadja; Stern, Jacob K

    Lip repositioning surgery to address excessive gingival display induced by different etiologies has received major attention recently. Several techniques and variations have been reported, including myotomy or repositioning of the levator labii superioris muscle, Le Fort impaction, maxillary gingivectomies, botulinum toxin injections, and lip stabilization. This study reports a case of excessive gingival display treated by a modified combined approach. A 25-year-old woman with a 4- to 8-mm gingival display when smiling caused by a combination of short clinical crowns induced by an altered passive eruption and hypermobility of the upper lip underwent a staged esthetic crown-lengthening procedure followed by a modified lip repositioning technique. A description of the technique and a comparison with other modes of therapy is discussed. This modified approach for treating the hypermobile lip included a bilateral removal of a partial-thickness strip of mucosa from the maxillary buccal vestibule without severing the muscle, leaving the midline frenum intact and suturing the lip mucosa to the mucogingival line. The narrower vestibule and increased tooth length resulted in a symmetric and pleasing gingival display when smiling that remained stable over time. With proper diagnosis and sequence of therapy, modified lip repositioning surgery combined with esthetic crown lengthening can be used predictably to treat excessive gingival display and enhance smile esthetics.

  2. Diagnostic Accuracy and Clinical Implications of Translabial Ultrasound for the Assessment of Levator Ani Defects and Levator Ani Biometry in Women With Pelvic Organ Prolapse: A Systematic Review.

    PubMed

    Notten, Kim J B; Vergeldt, Tineke F M; van Kuijk, Sander M J; Weemhoff, Mirjam; Roovers, Jan-Paul W R

    The aim of this study was to assess the diagnostic accuracy and clinical implications of translabial 3-dimensional (3D) ultrasound for the assessment of levator ani defects and biometry in women with pelvic organ prolapse (POP). We performed a systematic literature search through computerized databases including MEDLINE (via PubMed), EMBASE (via OvidSP), and the Cochrane Library using both medical subject headings and text terms from January 1, 2003, to December 25, 2015.We included articles that reported on POP status and diagnostic accuracy measurements with translabial 3D ultrasound or transperineal ultrasound for the detection of levator ani defects or for measuring pelvic floor biometry, that is, levator ani hiatus, or reported on the clinical relevance of using translabial 3D ultrasound for levator ani defects or measuring pelvic floor biometry in women with POP. Thirty-one articles were selected in accordance with parts of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines that can be applied to studies of diagnostic accuracy. Twenty-two articles (71%) are coauthored by 1 expert in this field. Detecting levator ani defects with translabial 3D ultrasound compared with magnetic resonance imaging showed a moderate to good agreement, whereas measuring hiatal biometry on translabial 3D ultrasound compared with magnetic resonance imaging showed a moderate to very good agreement.The interobserver agreement for diagnosing levator ani defects and measuring the levator hiatal area showed a moderate to very good agreement. Furthermore, levator ani defects increase the risk of cystocele and uterine prolapse, and levator ani defects are associated with recurrent POP.Finally, a larger hiatus was associated with POP and recurrent POP. Translabial 3D ultrasound is reproducible for diagnosing levator ani defects and ballooning hiatus. Both levator ani defects and a larger hiatal area are, in a selected population of patients with pelvic floor

  3. Detailed Anatomy of the Nasolabial Muscle in Human Fetuses as Determined by Micro-CT Combined With Iodine Staining.

    PubMed

    Wu, Jiajun; Yin, Ningbei

    2016-01-01

    This study aims to investigate the 3-dimensional (3D) anatomical structure of the orbicularis oris and nasalis, which are closely associated with the appearance of the upper lip and lower part of the nose. The relationship of the complicated 3D anatomical structure with the outline shape was also determined. Microcomputed tomography combined with iodine staining was used to scan the nasolabial tissues of 3 aborted fetuses. The strictly aligned, corrected, full-capacity, 2-dimensional (2D) grayscale images obtained were then used to reconstruct 3D structures using a 3D reconstruction software. 2D grayscale slices and a 3D anatomical model of the orbicularis oris and nasalis of the specimens were obtained. The 2D images and the 3D model confirmed the orbicularis oris anatomical structure reported in previous studies and also provided new insights (such as the close association of the formation of the philtral dimple, lip peak, philtral ridge, and nasal sill with the orbicularis oris). In addition, the results show that the nasolabial muscle consists of muscle fibers from different sources and is divided into four distinct parts: pars marginalis, pars peripheralis, muscle fibers of the levator labii superioris, and nasalis muscle fibers. The 3D anatomical structures indicate that the orbicularis oris and nasalis are closely associated with the appearances of the upper lip and lower part of the nose. The results may aid plastic surgeons in performing cleft-lip correction surgery.

  4. Depressor septi nasi modifications in rhinoplasty: a review of anatomy and surgical techniques.

    PubMed

    Benlier, Erol; Balta, Serkan; Tas, Suleyman

    2014-08-01

    The anatomy of the nasal muscles contributes a social harmony in aesthetic rhinoplasty because these muscles coordinate the nose and the upper lip while smiling. Sometimes this coordination can be interrupted by the hyperactivity or variations of these muscles and may result as a deformity because of their dynamic functions and relations with the nose. In our daily practice, we usually perform the rhinoplasty without considering the dynamic functions. When the patients recover the muscle functions after operation and start to use their mimics, such as smiling, the undamaged dynamic forces may start to rotate the tip of the nose inferiorly in a long-term period, correlated with their preoperative function. To avoid this unexpected rotation it is essential to remember preoperative examination of the smile patterns. To manage this functional part of rhinoplasty, we aimed to clarify the smiling patterns or deformities mainly focused on depressor septi nasi muscle in this article. This muscle creates downward movement of the nasal tip and shortens the upper lip during smiling. The overactivity of this muscle can aggravate the smiling deformity in some patients by a sharper nasolabial angle correlated with levator labii superioris alaeque nasi and orbicularis oris muscle activities. The article not only stresses the correction of this deformity, but also aims to guide their treatment alternatives for correlation of postoperative results and applicability in rhinoplasty. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Correlation Between Transperineal 3-Dimensional Ultrasound Measurements of Levator Hiatus and Female Sexual Function.

    PubMed

    Aydin, Serdar; Bakar, Rabia Zehra; Arioğlu Aydin, Çağri; Ateş, Seda

    The aim of this study is to investigate the association of sexual functions with levator hiatus biometry measurements and levator ani muscle defect. In 62 heterosexual, sexually active premenopausal women without pelvic floor disorders or urinary incontinence, 3-dimensional transperineal ultrasound imaging was used. Two 3-dimensional volumes were recorded, one at rest and one on Valsalva maneuver. Levator biometry measurements and levator defect were evaluated in an axial plane. Sexual function was assessed by a validated questionnaire, Female Sexual Function Index (FSFI). The primary outcome measure was correlation of sexual functions with the levator hiatus area, transverse and anteroposterior diameters, levator ani muscle thickness, vaginal length, and changes in measurements with Valsalva and levator defect. Forty-two women (67.7%) had low total FSFI scores (<26.55). Levator defect rates were similar in female sexual dysfunction (7/42, 16.7%) and women without female sexual dysfunction (5/20, 25%). The FSFI was negatively and weakly correlated with Δhiatal anteroposterior diameter (r = -0.33, P < 0.009) in the study population. There was a weak and inverse correlation between Δhiatal anteroposterior diameter and arousal (r = -0.35, P < 0.002), desire (r = -0.38, P < 0.001), and orgasm (r = -0.33, P < 0.007). Pain and lubrication did not correlate with any measurement. Hiatal area and diameters at rest are not related to sexual functions. Changes in anteroposterior diameter of the levator hiatus during Valsalva, which may be a sign of pelvic floor laxity or levator muscle weakness, are weakly associated with sexual functions, particularly desire, arousal, and orgasm domains.

  6. [Eyelid retraction of neurologic origin: Report of three cases].

    PubMed

    Cartier R, Luis; Guzmán S, Jorge; Pasquali F, Renzo

    2017-02-01

    Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out.

  7. Levator Ani Muscle Stretch Induced by Simulated Vaginal Birth

    PubMed Central

    Lien, Kuo-Cheng; Mooney, Brian; DeLancey, John O. L.; Ashton-Miller, James A.

    2005-01-01

    OBJECTIVE: To develop a three-dimensional computer model to predict levator ani muscle stretch during vaginal birth. METHODS: Serial magnetic resonance images from a healthy nulliparous 34-year-old woman, published anatomic data, and engineering graphics software were used to construct a structural model of the levator ani muscles along with related passive tissues. The model was used to quantify pelvic floor muscle stretch induced during the second stage of labor as a model fetal head progressively engaged and then stretched the iliococcygeus, pubococcygeus, and puborectalis muscles. RESULTS: The largest tissue strain reached a stretch ratio (tissue length under stretch/original tissue length) of 3.26 in medial pubococcygeus muscle, the shortest, most medial and ventral levator ani muscle. Regions of the ileococcygeus, pubococcygeus, and puborectalis muscles reached maximal stretch ratios of 2.73, 2.50, and 2.28, respectively. Tissue stretch ratios were proportional to fetal head size: For example, increasing fetal head diameter by 9% increased medial pubococcygeus stretch by the same amount. CONCLUSION: The medial pubococcygeus muscles undergo the largest stretch of any levator ani muscles during vaginal birth. They are therefore at the greatest risk for stretch-related injury. PMID:14704241

  8. Changes in Sunken Eyes Combined with Blepharoptosis after Levator Resection.

    PubMed

    Mawatari, Yuki; Fukushima, Mikiko; Kawaji, Takahiro

    2017-12-01

    This study aims to report the changes in sunken eyes combined with blepharoptosis after levator resection. Analysis involved 60 eyes from 32 patients with sunken eyes combined with blepharoptosis. Advancement of the levator aponeurosis and the Müller's muscle complex (levator resection) was performed in these patients. Area of upper eyelid sulcus (AES) was defined as the area of the upper eyelid shadow. The digital images were converted to black and white using image-processing software (Adobe Photoshop), and the AES was calculated using ImageJ software. In addition, margin reflex distance, eyebrow height (EBH), and AES were measured before and 3 months after surgery to assess the changes in the eyelids. Preoperative AES was significantly correlated to age ( P < 0.0001; r = 0.8062). Sunken eyes were remarkably improved after levator resection in all patients. Mean margin reflex distance significantly increased, whereas mean EBH and mean AES significantly decreased at 3 months after surgery ( P < 0.0001). The AES change was significantly correlated to the EBH change ( P < 0.0001; r = 0.5184). The principal aim of levator resection is to improve upper eyelid height and visual fields; however, this technique can alter the location of the eyebrow and upper orbital fat. The effects fill the hollowness of the upper eyelid and can remarkably improve sunken eyes.

  9. Androgen-estrogen synergy in rat levator ani muscle Glucose-6-phosphate dehydrogenase

    NASA Technical Reports Server (NTRS)

    Max, S. R.

    1984-01-01

    The effects of castration and hormone administration on the activity of glucose-6-phosphate dehydrogenase in the rat levator ani muscle were studied. Castration caused a decrease in enzyme activity and in wet weight of the levator ani muscle. Chronic administration of testosterone propionate increased glucose-6-phosphate dehydrogenase activity in the levator ani muscle of castrated rats; the magnitude of the recovery of enzyme activity was related to the length of time of exposure to testosterone propionate after castration as well as to the length of time the animals were castrated. The longer the period of castration before exposure to testosterone propionate, the greater the effect. This result may be related to previously reported castration-mediated increases in androgen receptor binding in muscle. Dihydrotestosterone was less effective than testosterone propionate in enhancing glucose-6-phosphate dehydrogenase activity in the levator ani muscle from castrated rats; estradiol-17-beta alone was ineffective. Combined treatment with estradiol-17-beta and dihydrotestosterone, however, was as effective as testosterone alone. Thus, androgens and estrogens may exert synergistic effects on levator ani muscle.

  10. Outcomes of levator resection at tertiary eye care center in Iran: a 10-year experience.

    PubMed

    Abrishami, Alireza; Bagheri, Abbas; Salour, Hossein; Aletaha, Maryam; Yazdani, Shahin

    2012-02-01

    To assess outcomes of levator resection for the surgical correction of congenital and acquired upper lid ptosis in patients with fair to good levator function and evaluation of the relationship between demographic data and success of this operation. In a retrospective study, medical records of patients with blepharoptosis who had undergone levator resection over a 10-year period and were followed for at least 3 months were reviewed. Overall, 136 patients including 60 (44.1%) male and 76 (55.9%) female subjects with a mean age of 20 ± 13.8 years (range, 2 to 80 years) were evaluated, of whom 120 cases (88.2%) had congenital ptosis and the rest had acquired ptosis. The overall success rate after the first operation was 78.7%. The most common complication after the first operation was undercorrection in 26 cases (19.1%), which was more prevalent among young patients (p = 0.06). Lid fissure and margin reflex distance (MRD(1)) also increased after levator resection (p < 0.001). Age, sex, type of ptosis, amblyopia, levator function, MRD(1), lid fissure and spherical equivalent were not predictive of surgical outcomes of levator resection. Levator resection has a high rate of success and few complications in the surgical treatment of congenital and acquired upper lid ptosis with fair to good levator function. Reoperation can be effective in most cases in which levator resection has been performed.

  11. Levator hiatal area as a risk factor for cystocele recurrence after surgery: a prospective study.

    PubMed

    Vergeldt, T F M; Notten, K J B; Weemhoff, M; van Kuijk, S M J; Mulder, F E M; Beets-Tan, R G; Vliegen, R F A; Gondrie, E T C M; Bergmans, M G M; Roovers, J P W R; Kluivers, K B

    2015-07-01

    To investigate whether increased levator hiatal area, measured preoperatively, was independently associated with anatom-ical cystocele recurrence 12 months after anterior colporrhaphy. Multicentre prospective cohort study. Nine teaching hospitals in the Netherlands. Women planned for conventional anterior colporrhaphy without mesh. Women underwent physical examination, translabial three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) prior to surgery. At 12 months after surgery the physical examination was repeated. Women with and without anatomical cystocele recurrence were compared to assess the association with levator hiatal area on 3D ultrasound, levator hiatal area on MRI, and potential confounding factors. The receiver operating characteristic (ROC) curve was created to quantify the discriminative ability of using levator hiatal area to predict anatomical cystocele recurrence. Of 139 included women, 76 (54.7%) had anatomical cystocele recurrence. Preoperative stage 3 or 4 and increased levator hiatal area during Valsalva on ultrasound were significantly associated with cystocele recurrence, with odds ratios of 3.47 (95% confidence interval, 95% CI 1.66-7.28) and 1.06 (95% CI 1.01-1.11) respectively. The area under the ROC curve was 0.60 (95% CI 0.51-0.70) for levator hiatal area during Valsalva on ultrasound, and 0.65 (95% CI 0.55-0.71) for preoperative Pelvic Organ Prolapse Quantification (POP-Q) stage. Increased levator hiatal area during Valsalva on ultrasound prior to surgery and preoperative stage 3 or 4 are independent risk factors for anatomical cystocele recurrence after anterior colporrhaphy; however, increased levator hiatal area as the sole factor for predicting anatomical cystocele recurrence after surgery shows poor test characteristics. © 2015 Royal College of Obstetricians and Gynaecologists.

  12. [Anatomy of the levator ani muscle and implications for obstetrics and gynaecology].

    PubMed

    Nyangoh Timoh, K; Bessede, T; Zaitouna, M; Peschaud, F; Chevallier, J-M; Fauconnier, A; Benoit, G; Moszkowicz, D

    2015-01-01

    Pelvic floor disorders include urogenital and anorectal prolapse, urinary and faecal incontinence. These diseases affect 25% of patients. Most of time, treatment is primarily surgical with a high post-operative risk of recurrence, especially for pelvic organ prolapse. Vaginal delivery is the major risk factor for pelvic floor disorders through levator ani muscle injury or nerve damage. After vaginal delivery, 20% of patients experiment elevator ani trauma. These injuries are more common in case of instrumental delivery by forceps, prolonged second phase labor, increased neonatal head circumference and associated anal sphincter injuries. Moreover, 25% of patients have temporary perineal neuropathy. Recently, pelvic three-dimensional reconstructions from RMI data allowed a better understanding of detailed levator ani muscle morphology and gave birth to a clear new nomenclature describing this muscle complex to be developed. Radiologic and anatomic studies have allowed exploring levator ani innervation leading to speculate on the muscle and nerve damage mechanisms during delivery. We then reviewed the levator ani muscle anatomy and innervation to better understand pelvic floor dysfunction observed after vaginal delivery. Copyright © 2015. Published by Elsevier SAS.

  13. Ptosis induced by topical steroid eye drops: Two cases reports.

    PubMed

    Zhu, Yanan; Sun, Chaohui; Zhang, Xin; Shentu, Xingchao

    2017-12-01

    Ptosis is a rare complication of periocular steroid use. Studies report that local injections of steroids produce ptosis. We describe the first 2 cases of ptosis because of long-term treatment with topical steroid eye drops. Two cases admitted to our hospital because of ptosis of their right eye after long-term treatment with topical steroid eye drops. Both of them had uncontrolled Posner-Schlossman syndrome. Two cases were diagnosed as steroid-related ptosis. Regulatory anti-inflammation therapy was prescribed for case 1, and after inflammation control, phacoemulsification was done for her. Six months after steroid withdrawal, the levator resection of the right eye was performed. Case 2 refused our advice of steroid reduction and ptosis surgery. After surgery, case 1 retained a symmetrical appearance during a 1-year follow-up. In the surgery, we found thin levator muscles and slack levator palpebrae superioris aponeurosis (LPSA) in the affected eye. Postoperative transmission electron microscopy revealed typical signs of apoptosis in levator muscle cells. We suggest topical application of steroids induces levator muscle apoptosis and LPSA weakness, and results in ptosis. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  14. Cytosolic androgen receptor in regenerating rat levator ani muscle.

    PubMed Central

    Max, S R; Mufti, S; Carlson, B M

    1981-01-01

    The development of the cytosolic androgen receptor was studied after degeneration and regeneration of the rat levator ani muscle after a crush lesion. Muscle regeneration appears to recapitulate myogenesis in many respects. It therefore provides a model tissue in sufficiently in large quantity for investigating the ontogenesis of the androgen receptor. The receptor in the cytosol of the normal levator ani muscle has binding characteristics similar to those of the cytosolic receptor in other androgen-sensitive tissues. By day 3 after a crush lesion of the levator ani muscle, androgen binding decreased to 25% of control values. This decrease was followed by a 4-5 fold increase in hormone binding, which attained control values by day 7 after crush. Androgen binding remained stable at the control value up to day 60 after crushing. These results were correlated with the morphological development of the regenerating muscle after crushing. It is concluded that there is little, if any, androgen receptor present in the early myoblastic stages of regeneration; rather, synthesis of the receptor may occur after the fusion of myoblasts and during the differentiation of myotubes into cross-striated muscle fibres. Images PLATE 1 PLATE 2 PMID:6977357

  15. Predictive images of postoperative levator resection outcome using image processing software.

    PubMed

    Mawatari, Yuki; Fukushima, Mikiko

    2016-01-01

    This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection. Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller's muscle complex (levator resection). Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop ® ). Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery. Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2%) were satisfied with their postoperative appearances, and 55 patients (84.8%) positively responded to the usefulness of processed images to predict postoperative appearance. Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery.

  16. Predictive images of postoperative levator resection outcome using image processing software

    PubMed Central

    Mawatari, Yuki; Fukushima, Mikiko

    2016-01-01

    Purpose This study aims to evaluate the efficacy of processed images to predict postoperative appearance following levator resection. Methods Analysis involved 109 eyes from 65 patients with blepharoptosis who underwent advancement of levator aponeurosis and Müller’s muscle complex (levator resection). Predictive images were prepared from preoperative photographs using the image processing software (Adobe Photoshop®). Images of selected eyes were digitally enlarged in an appropriate manner and shown to patients prior to surgery. Results Approximately 1 month postoperatively, we surveyed our patients using questionnaires. Fifty-six patients (89.2%) were satisfied with their postoperative appearances, and 55 patients (84.8%) positively responded to the usefulness of processed images to predict postoperative appearance. Conclusion Showing processed images that predict postoperative appearance to patients prior to blepharoptosis surgery can be useful for those patients concerned with their postoperative appearance. This approach may serve as a useful tool to simulate blepharoptosis surgery. PMID:27757008

  17. Anatomical study of the opossum (Didelphis albiventris) extraocular muscles.

    PubMed Central

    Matheus, S M; Soares, J C; da Silva, A M; Seullner, G

    1995-01-01

    The anatomy of the extraocular muscles was studied in 10 adult opossums (Didelphis albiventris) of both sexes. Eight extraocular muscles were identified: 4 rectus muscles, 2 oblique muscles, the levator palpebrae superioris and the retractor ocular bulbi. The rectus muscles originate very close one to another between the orbital surfaces of the presphenoid and palatine bones. These muscles diverge on the way to their insertion which occurs at about 2 mm from the limbus. The levator palpebrae superioris originates with the dorsal rectus and is positioned dorsally in relation to it. The retractor ocular bulbi forms a cone which embraces the optic nerve and is located internally in relation to the rectus muscles. The dorsal oblique originates on the presphenoid bone and after a tendinous trajectory through a trochlea on the medial wall of the orbit, inserts into the ocular bulb. The only muscle arising from the anterior orbital floor is the ventral oblique. The main nerve supply for these muscles is the oculomotor, except for the dorsal oblique which is innervated by the trochlear nerve, and the lateral rectus which is innervated by the abducens nerve. The retractor ocular bulbi receives branches from the inferior division of the oculomotor nerve and some branches from the abducens nerve. Images Fig. 1 Fig. 2 Fig. 3 PMID:7649843

  18. The effect of cleft maxillary distraction osteogenesis on the levator veli palatini and velopharyngeal function.

    PubMed

    Chen, Philip Kuo-Ting; Por, Yong-Chen; Liou, Eric Jein-Wein; Chang, Frank Chun-Shin

    2015-05-01

    Le Fort I maxillary distraction with the rigid external distraction (RED) device is performed to correct severe midface retrusion in cleft patients, but it may adversely affect velopharyngeal function. This study aims to investigate the angular changes in the levator veli palatini (LVP) and its influence on velopharyngeal function after maxillary distraction using 3-dimensional computed tomography (3D CT) scan volume rendered images. This was a retrospective study of 12 patients. Group 1 had no velopharyngeal function deterioration and group 2 had velopharyngeal function deterioration. Preoperative and 1 year postoperative CT scans were analyzed with Mimics v10 software. Segmentation of the LVP and the nasopharyngeal airway was performed and volumetric images were obtained. Six measurements were made: (1) the angle between the levator plane and the Frankfort horizontal, (2) the angle between the levator plane and the soft palate plane, (3) the angle between the 2 LVP muscles, (4) the pharyngeal depth, and (5, 6) the movement of the inferior pharyngeal point with respect to the horizontal and vertical planes. The independent samples t test, Mann-Whitney test, and paired t tests were used for statistical analyses (P < 0.05). Group 2 had statistically significant reduction in the angle between the levator plane and Frankfort horizontal as well as the soft palate plane. Group 1 had a statistically significant increase in the pharyngeal depth and movement of the inferior pharyngeal point with respect to the horizontal plane. A decrease in the angle between the levator plane and the Frankfort horizontal or the soft palate plane was associated with velopharyngeal function deterioration.

  19. In vivo evidence of significant levator ani muscle stretch on MR images of a live childbirth.

    PubMed

    Sindhwani, Nikhil; Bamberg, Christian; Famaey, Nele; Callewaert, Geertje; Dudenhausen, Joachim W; Teichgräber, Ulf; Deprest, Jan

    2017-08-01

    Vaginal childbirth is believed to be a significant risk factor for the development of pelvic floor dysfunction later in life. Previous studies have explored the use of medical imaging and simulations of childbirth to determine the stretch in the levator ani muscle. A report in 2012 has recorded magnetic resonance images of a live childbirth of a 24 year old woman giving birth vaginally for the second time, using a 1.0 Tesla open, high-field scanner. Our objective was to determine the stretch ratios in the levator muscle using these magnetic resonance images of live childbirth. Three-dimensional magnetic resonance image sequences were obtained to visualize coronal and axial planes before and after the childbirth. These images were obtained before the expulsion phase without pushing and were used to reconstruct the levator muscle and the fetal head in 3 dimensions. The fetal head was approximated to be an ellipsoid, and it is assumed that its middle section is visible in dynamic magnetic resonance images. Assuming incompressibility, the full deformation field of the fetal head is then calculated. Real-time cine magnetic resonance images were acquired for the during the expulsion phase, occurring over 2 contractions in the midsagittal plane. The levator muscle stretch is estimated using a custom program. The program calculates points of contact between the fetal head ellipsoid and the levator ani muscle model as the head descends down the birth canal and moves them orthogonal to its surface. Circumferential stretch was calculated to represent the extension needed to allow the passage of the fetal head. Starting from a position in the preexpulsion phase, the levator muscle experiences a maximum circumferential stretch of 248% on the posterior-medial portion of the levator ani muscle, as shown in previously published finite element simulations. However, the maximal stretch was notably less than that predicted by finite element models. This is because our baseline 3

  20. [Dynamic study of the female levator ani muscle using MRI 3D vectorial modeling].

    PubMed

    Delmas, Vincent; Ami, Olivier; Iba-Zizen, Marie-Thérèse

    2010-06-01

    The levator ani muscle has a major role in the female pelvic floor, and is involved in the pathophysiology of pelvic prolapse and stress urinary incontinence. We conducted an anatomical and morphological study of this muscle using dynamic 3D vectorial reconstruction MRI, in order to analyze the contraction of two major components of the levator ani: the iliococcygeus and pubococcygeus. Three volunteer healthy continent nulliparous women aged from 19 to 22 underwent dynamic pelvic MRI. Coronal T2-weighted pelvic images were obtained in the supine position, at rest, holding back, and during Valsalva stress effort. 3D vectorial models were reconstructed by manual segmentation of the source images, and were set up on bony anatomic marks. Iliococcygeus and pubococcygeus volumes were measured in the three positions. Volumetrics, displacement and dynamic morphing changes were analyzed with 3D vectorial animation software. The urogenital hiatus extended more holding back (mean +4.31 mm) than on effort (mean +2.78 mm). The iliococcygeus lowered (mean -3.95 mm) and deviated outward (mean +3.01 mm). The basic tone of the iliococcygeus muscle gives it a dome shape, and its reflex contraction against abdominal strain ensures anal and urinary continence The levator ani is more than a pelvic diaphragm: it is a truly dynamic pelvic floor. Its points of support on the stiff osseous frame allow it to retain the pelvic organs. The levator ani muscle seems to prevent anal prolapse during stress strain.

  1. Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction.

    PubMed

    Sun, Jing; Liu, Xingtong; Zhang, Yidan; Huang, Yazhuo; Zhong, Sisi; Fang, Sijie; Zhuang, Ai; Li, Yinwei; Zhou, Huifang; Fan, Xianqun

    2018-05-02

    BACKGROUND Eyelid retraction is the most common and often the first sign of thyroid eye disease (TED). Upper-eyelid retraction causes both functional and cosmetic problems. In order to correct the position of the upper eyelid, surgery is required. Many procedures have demonstrated good outcomes in mild and moderate cases; however, unpredictable results have been obtained in severe cases. Dryden introduced an upper-eyelid-lengthening procedure, which used scleral grafts, but outcomes were unsatisfactory. A new technique is introduced in this study as a reasonable alternative for TED-related severe upper-eyelid retraction correction. MATERIAL AND METHODS An innovative technique for levator lengthening using bovine acellular dermal matrix as a spacer graft is introduced for severe upper-eyelid retraction secondary to TED. Additionally, 2 modifications were introduced: the fibrous cords scattered on the surface of the levator aponeurosis were excised and the orbital fat pad anterior to the aponeurosis was dissected and sutured into the skin closure in a "skin-tarsus-fat-skin" fashion. RESULTS The modified levator-lengthening surgery was performed on 32 eyelids in 26 patients consisting of 21 women and 5 men (mean age, 37.8 years; age range, 19-67 years). After corrective surgery, the average upper margin reflex distance was lowered from 7.7±0.85 mm to 3.3±0.43 mm. Eighteen cases (69%) had perfect results, while 6 cases (23%) had acceptable results. CONCLUSIONS A modified levator-lengthening procedure using bovine acellular dermal matrix as a spacer graft ameliorated both the symptoms and signs of severe upper-eyelid retraction secondary to TED. This procedure is a reasonable alternative for correction of TED-related severe upper-eyelid retraction.

  2. A possible role for endogenous glucocorticoids in orchiectomy-induced atrophy of the rat levator ani muscle - Studies with RU 38486, a potent and selective antiglucocorticoid

    NASA Technical Reports Server (NTRS)

    Konagaya, Masaaki; Max, Stephen R.

    1986-01-01

    RU38486, a potent and selective antiglucocorticoid, was employed to study a possible role for endogenous glucocorticoids in atrophy of the levator ani muscle secondary to castration of male rats. RU38486 was shown to block (3H) triamcinolone acetonide binding to cytosol from levator ani muscle. Daily oral administration of RU38486 to castrated rats partially prevented atrophy of the levator ani muscle, as well as a decrease in RNA concentration. In a control group receiving RU38486 alone, the levator ani underwent significant 20 percent hypertrophy. Administration of exogenous dexamethasone also caused pronounced atrophy of the levator ani muscle. This atrophy was prevented, to a significant degree, by simultaneous oral administration of Ru38486. It is concluded that endogenous glucocorticoids, the actions of which are blocked by RU38486, may be involved in regulation of the mass of the levator ani muscle in intact rats.

  3. A possible role for endogenous glucocorticoids in orchiectomy-induced atrophy of the rat levator ani muscle: Studies with RU38486, a potent and selective antiglucocorticoid

    NASA Technical Reports Server (NTRS)

    Konagaya, M.; Max, S. R.

    1985-01-01

    RU38486, a potent and selective antiglucocorticoid, was employed to study a possible role for endogenous glucocorticoids in atrophy of the levator ani muscle secondary to castration of male rats. RU38486 was shown to block (3H) triamcinolone acetonide binding to cytosol from levator ani muscle. Daily oral administration of RU38486 to castrated rats partially prevented atrophy of the levator ani muscle, as well as a decrease in RNA concentration. In a control group receiving RU38486 alone, the levator ani underwent significant (20%) hypertrophy. Administration of exogenous dexamethasone also caused pronounced atrophy of the levator ani muscle. This atrophy was prevented, to a significant degree, by simultaneous oral administration of RU38486. It is concluded that endogenous glucocorticoids, the actions of which are blocked by RU38486, may be involved in regulation of the mass of the levator ani muscle in intact rats.

  4. Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

    PubMed Central

    Pai, Vishwas D.; Engineer, Reena; Patil, Prachi S.; Arya, Supreeta; Desouza, Ashwin L.

    2016-01-01

    Background To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes. Methods This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ2-test was used to compare the results between the two groups. Results Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study. Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance. Conclusions ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient. PMID:27284466

  5. Bovine Acellular Dermal Matrix for Levator Lengthening in Thyroid-Related Upper-Eyelid Retraction

    PubMed Central

    Sun, Jing; Liu, Xingtong; Zhang, Yidan; Huang, Yazhuo; Zhong, Sisi; Fang, Sijie; Zhuang, Ai; Li, Yinwei; Zhou, Huifang

    2018-01-01

    Background Eyelid retraction is the most common and often the first sign of thyroid eye disease (TED). Upper-eyelid retraction causes both functional and cosmetic problems. In order to correct the position of the upper eyelid, surgery is required. Many procedures have demonstrated good outcomes in mild and moderate cases; however, unpredictable results have been obtained in severe cases. Dryden introduced an upper-eyelid-lengthening procedure, which used scleral grafts, but outcomes were unsatisfactory. A new technique is introduced in this study as a reasonable alternative for TED-related severe upper-eyelid retraction correction. Material/Methods An innovative technique for levator lengthening using bovine acellular dermal matrix as a spacer graft is introduced for severe upper-eyelid retraction secondary to TED. Additionally, 2 modifications were introduced: the fibrous cords scattered on the surface of the levator aponeurosis were excised and the orbital fat pad anterior to the aponeurosis was dissected and sutured into the skin closure in a “skin-tarsus-fat-skin” fashion. Results The modified levator-lengthening surgery was performed on 32 eyelids in 26 patients consisting of 21 women and 5 men (mean age, 37.8 years; age range, 19–67 years). After corrective surgery, the average upper margin reflex distance was lowered from 7.7±0.85 mm to 3.3±0.43 mm. Eighteen cases (69%) had perfect results, while 6 cases (23%) had acceptable results. Conclusions A modified levator-lengthening procedure using bovine acellular dermal matrix as a spacer graft ameliorated both the symptoms and signs of severe upper-eyelid retraction secondary to TED. This procedure is a reasonable alternative for correction of TED-related severe upper-eyelid retraction. PMID:29718902

  6. Levator Glandulae Thyroideae, a Fibromusculoglandular Band with Absence of Pyramidal Lobe and Its Innervation: A Case Report

    PubMed Central

    Chaudhary, Priti; Singh, Zora; Khullar, Meenakshi; Arora, Kamal

    2013-01-01

    Amongst the endocrine glands, thyroid gland is well known for its developmental anomalies, which range from common to rare ones. The presence of levator glandulae thyroideae and its anatomical variations gain importance in the pathologies which are related to thyroid gland and their treatment modalities. Levator glandulae thyroideae is a fibromuscular band. If it is present, it is usually seen on the left side, to connect the pyramidal lobe of thyroid gland and the hyoid bone. But levator glandulae thyroideae which stretches from isthmus to the body of hyoid bone is rare and only very few cases have been reported in the medical literature. During a routine dissection of the thyroid gland in a 55 years old male cadaver, a Levator Glandulae Thyroideae (which was fibromusculoglandular in nature) was seen, with the absence of pyramidal lobe on the left side. It directly came from upper border of isthmus and went upto hyoid bone. It also had innervation from branches of external laryngeal nerve. This was also associated with absence of superior thyroid artery on the same side. The knowledge on various developmental anomalies of the gland and variations in neurovascular relations will help the surgeons in plan thyroid surgeries in a better and safe way. PMID:23998080

  7. Is it necessary to diagnose levator avulsion on pelvic floor muscle contraction?

    PubMed

    Dietz, H P; Pattillo Garnham, A; Guzmán Rojas, R

    2017-02-01

    Avulsion of the levator ani muscle commonly occurs at vaginal birth. This condition is usually diagnosed by translabial ultrasound (TLUS) during pelvic floor muscle contraction (PFMC). Some patients are unable to achieve a satisfactory PFMC and in these cases avulsion is assessed at rest. The aim of this study was to validate the diagnosis of levator avulsion by means of TLUS at rest. This was a retrospective study of 233 women seen at a tertiary urogynecological center. All women underwent four-dimensional TLUS in the supine position and after voiding. Volumes were obtained on maximal PFMC and at rest. Analysis of the volumes was performed with the observer blinded against all clinical data. Avulsion was defined as an abnormal levator ani muscle insertion that was visible in at least three consecutive axial plane slices, at and above the level of minimal hiatal dimensions, at 2.5-mm intervals. We examined the correlation between both assessment methods using Cohen's kappa coefficient and tested the association of each method with female pelvic organ prolapse on clinical examination, organ descent on ultrasound and hiatal ballooning. In total, datasets from 202 women were available for analysis. The correlation between a diagnosis of avulsion in volumes obtained at rest and those on PFMC was moderate, with a kappa value of 0.583 (95% CI, 0.484-0.683). Agreement for defects visualized on single slices was moderate, with a kappa value of 0.556 (95% CI, 0.520-0.591). When avulsion diagnoses at rest and on PFMC were tested against symptoms of prolapse, and prolapse on clinical examination and on ultrasound, neither of the two methods was superior. Although tomographic ultrasound imaging during PFMC enhances tissue discrimination, this may not translate to superior diagnostic performance. Hence, volumes obtained at rest may be used in women unable to contract their pelvic floor. The diagnosis of levator avulsion by tomographic pelvic floor ultrasound is equally valid

  8. Comparison of translabial three-dimensional ultrasound with magnetic resonance imaging for measurement of levator hiatal biometry at rest.

    PubMed

    Vergeldt, T F M; Notten, K J B; Stoker, J; Fütterer, J J; Beets-Tan, R G; Vliegen, R F A; Schweitzer, K J; Mulder, F E M; van Kuijk, S M J; Roovers, J P W R; Kluivers, K B; Weemhoff, M

    2016-05-01

    To compare translabial three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for the measurement of levator hiatal biometry at rest in women with pelvic organ prolapse, and to determine the interobserver reliability between two independent observers for ultrasound and MRI measurements. Data were derived from a multicenter prospective cohort study in which women scheduled for conventional anterior colporrhaphy underwent translabial 3D ultrasound and MRI prior to surgery. Intraclass correlation coefficients (ICCs) were calculated to estimate interobserver reliability between two independent observers and determine the agreement between ultrasound and MRI measurements. Bland-Altman plots were created to assess the agreement between ultrasound and MRI measurements. Data from 139 women from nine hospitals were included in the study. The interobserver reliability of ultrasound assessment at rest, during Valsalva maneuver and during contraction and of MRI assessment at rest were moderate or good. The agreement between ultrasound and MRI for the measurement of levator hiatal biometry at rest was moderate, with ICCs of 0.52 (95%CI, 0.32-0.66) for levator hiatal area, 0.44 (95%CI, 0.21-0.60) for anteroposterior diameter and 0.44 (95%CI, 0.22-0.60) for transverse diameter. Levator hiatal biometry measurements were statistically significantly larger on MRI than on translabial 3D ultrasound. The agreement between translabial 3D ultrasound and MRI for measurement of the levator hiatus at rest in women with pelvic organ prolapse was only moderate. The results of translabial 3D ultrasound and MRI should therefore not be used interchangeably in daily practice or in clinical research. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  9. A Geometric Capacity–Demand Analysis of Maternal Levator Muscle Stretch Required for Vaginal Delivery

    PubMed Central

    Tracy, Paige V.; DeLancey, John O.; Ashton-Miller, James A.

    2016-01-01

    Because levator ani (LA) muscle injuries occur in approximately 13% of all vaginal births, insights are needed to better prevent them. In Part I of this paper, we conducted an analysis of the bony and soft tissue factors contributing to the geometric “capacity” of the maternal pelvis and pelvic floor to deliver a fetal head without incurring stretch injury of the maternal soft tissue. In Part II, we quantified the range in demand, represented by the variation in fetal head size and shape, placed on the maternal pelvic floor. In Part III, we analyzed the capacity-to-demand geometric ratio, g, in order to determine whether a mother can deliver a head of given size without stretch injury. The results of a Part I sensitivity analysis showed that initial soft tissue loop length (SL) had the greatest effect on maternal capacity, followed by the length of the soft tissue loop above the inferior pubic rami at ultimate crowning, then subpubic arch angle (SPAA) and head size, and finally the levator origin separation distance. We found the more caudal origin of the puborectal portion of the levator muscle helps to protect it from the stretch injuries commonly observed in the pubovisceral portion. Part II fetal head molding index (MI) and fetal head size revealed fetal head circumference values ranging from 253 to 351 mm, which would increase up to 11 mm upon face presentation. The Part III capacity-demand analysis of g revealed that, based on geometry alone, the 10th percentile maternal capacity predicted injury for all head sizes, the 25th percentile maternal capacity could deliver half of all head sizes, while the 50th percentile maternal capacity could deliver a head of any size without injury. If ultrasound imaging could be operationalized to make measurements of ratio g, it might be used to usefully inform women on their level of risk for levator injury during vaginal birth. PMID:26746116

  10. A Geometric Capacity-Demand Analysis of Maternal Levator Muscle Stretch Required for Vaginal Delivery.

    PubMed

    Tracy, Paige V; DeLancey, John O; Ashton-Miller, James A

    2016-02-01

    Because levator ani (LA) muscle injuries occur in approximately 13% of all vaginal births, insights are needed to better prevent them. In Part I of this paper, we conducted an analysis of the bony and soft tissue factors contributing to the geometric "capacity" of the maternal pelvis and pelvic floor to deliver a fetal head without incurring stretch injury of the maternal soft tissue. In Part II, we quantified the range in demand, represented by the variation in fetal head size and shape, placed on the maternal pelvic floor. In Part III, we analyzed the capacity-to-demand geometric ratio, g, in order to determine whether a mother can deliver a head of given size without stretch injury. The results of a Part I sensitivity analysis showed that initial soft tissue loop length (SL) had the greatest effect on maternal capacity, followed by the length of the soft tissue loop above the inferior pubic rami at ultimate crowning, then subpubic arch angle (SPAA) and head size, and finally the levator origin separation distance. We found the more caudal origin of the puborectal portion of the levator muscle helps to protect it from the stretch injuries commonly observed in the pubovisceral portion. Part II fetal head molding index (MI) and fetal head size revealed fetal head circumference values ranging from 253 to 351 mm, which would increase up to 11 mm upon face presentation. The Part III capacity-demand analysis of g revealed that, based on geometry alone, the 10th percentile maternal capacity predicted injury for all head sizes, the 25th percentile maternal capacity could deliver half of all head sizes, while the 50th percentile maternal capacity could deliver a head of any size without injury. If ultrasound imaging could be operationalized to make measurements of ratio g, it might be used to usefully inform women on their level of risk for levator injury during vaginal birth.

  11. Repair of a submucous cleft palate by W-pushback and levator repositioning without incision to the nasal mucosa.

    PubMed

    Hwang, Kun

    2012-03-01

    The author created an innovative method of W-pushback and levator repositioning without having to make an incision to the nasal mucosa for submucous cleft palate repair.The W-shaped mucoperiosteal flap is outlined where the 2 peaks of W are the alveolar processes of both canine teeth and the midpoint of W is the anterior limit of the cleft notch of the hard palate. A short incision, medial to and behind the maxillary tuberosity and curved forward onto the palate and extended forward just medial to the alveolar process, is joined by a second incision from the apex of the cleft to the region of the canine tooth. The W-shaped mucoperiosteal flap is raised until the midline notch of the hard palate is exposed. The nasal mucosa and abnormally inserted levator veli palatini muscle to the posterior border of the hard palate bone are detached. By leaving the nasal mucosa intact, the detached levator veli palatini muscle is approximated at the midline and so the zona pellucida is obliterated. The cleft uvulas are cut in half and closed. The approximated W-flap is joined to the small anterior flap by 1 or more sutures (the W-pushback).Three patients were operated on with this technique without serious complications.The author believes that this method can make the levator sling and increase the length of the soft palate without making an incision to the nasal mucosa.

  12. Comparison of trophic factors' expression between paralyzed and recovering muscles after facial nerve injury. A quantitative analysis in time course.

    PubMed

    Grosheva, Maria; Nohroudi, Klaus; Schwarz, Alisa; Rink, Svenja; Bendella, Habib; Sarikcioglu, Levent; Klimaschewski, Lars; Gordon, Tessa; Angelov, Doychin N

    2016-05-01

    After peripheral nerve injury, recovery of motor performance negatively correlates with the poly-innervation of neuromuscular junctions (NMJ) due to excessive sprouting of the terminal Schwann cells. Denervated muscles produce short-range diffusible sprouting stimuli, of which some are neurotrophic factors. Based on recent data that vibrissal whisking is restored perfectly during facial nerve regeneration in blind rats from the Sprague Dawley (SD)/RCS strain, we compared the expression of brain derived neurotrophic factor (BDNF), fibroblast growth factor-2 (FGF2), insulin growth factors 1 and 2 (IGF1, IGF2) and nerve growth factor (NGF) between SD/RCS and SD-rats with normal vision but poor recovery of whisking function after facial nerve injury. To establish which trophic factors might be responsible for proper NMJ-reinnervation, the transected facial nerve was surgically repaired (facial-facial anastomosis, FFA) for subsequent analysis of mRNA and proteins expressed in the levator labii superioris muscle. A complicated time course of expression included (1) a late rise in BDNF protein that followed earlier elevated gene expression, (2) an early increase in FGF2 and IGF2 protein after 2 days with sustained gene expression, (3) reduced IGF1 protein at 28 days coincident with decline of raised mRNA levels to baseline, and (4) reduced NGF protein between 2 and 14 days with maintained gene expression found in blind rats but not the rats with normal vision. These findings suggest that recovery of motor function after peripheral nerve injury is due, at least in part, to a complex regulation of lesion-associated neurotrophic factors and cytokines in denervated muscles. The increase of FGF-2 protein and concomittant decrease of NGF (with no significant changes in BDNF or IGF levels) during the first week following FFA in SD/RCS blind rats possibly prevents the distal branching of regenerating axons resulting in reduced poly-innervation of motor endplates. Copyright

  13. Isolated upper eyelid retraction: a sign of idiopathic inflammatory orbital disease.

    PubMed

    Shome, Debraj; Toshniwal, Svetlana; Jain, Vandana; Natarajan, Sundaram; Vemuganti, Geeta K

    2008-01-01

    A 41-year-old woman was examined for left upper eyelid retraction. Remaining ocular and systemic examination was unremarkable. Orbital CT demonstrated an ill-defined, extraconal, superior orbital soft-tissue mass involving the levator palpebrae superioris muscle. Incisional biopsy with histopathology demonstrated idiopathic orbital inflammation. The patient was started on a gradually tapering dose of oral steroids, for 6 weeks. On follow-up, the eyelid retraction had resolved. We report this case to demonstrate that idiopathic inflammatory orbital disease, localized to the superior orbit, may cause isolated upper eyelid retraction without associated proptosis. This condition resolves with medical therapy, leading to symmetrical palpebral apertures.

  14. Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus.

    PubMed

    Dietz, H P; Bhalla, R; Chantarasorn, V; Shek, K L

    2011-06-01

    To determine the degree of levator hiatal asymmetry in women with unilateral avulsion of the puborectalis muscle in order to estimate the likely effect of successful reconstruction. We reviewed datasets of women seen between May 2005 and January 2009 in a tertiary urogynecological unit. Archived ultrasound volume datasets were analyzed for hiatal dimensions and puborectalis muscle trauma in patients with unilateral avulsion. From 929 eligible datasets we identified 71 patients with isolated complete unilateral tears. Unilateral avulsion was associated with a significant increase in hiatal area (P ≤ 0.002). Relative to a hypothetical normal hiatus (intact hemi-area × 2), avulsion was associated with a larger hiatus on Valsalva maneuver (+2.1 cm(2) or 7%). Unilateral puborectalis muscle avulsion results in an asymmetric increase in the size of the levator hiatus. This increase is relatively minor, accounting for < 10% of hiatal area. Surgical repair of an avulsion may have only limited effects on hiatal dimensions. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  15. Automatic segmentation method of pelvic floor levator hiatus in ultrasound using a self-normalizing neural network

    PubMed Central

    Dietz, Hans Peter; D’hooge, Jan; Barratt, Dean; Deprest, Jan

    2018-01-01

    Abstract. Segmentation of the levator hiatus in ultrasound allows the extraction of biometrics, which are of importance for pelvic floor disorder assessment. We present a fully automatic method using a convolutional neural network (CNN) to outline the levator hiatus in a two-dimensional image extracted from a three-dimensional ultrasound volume. In particular, our method uses a recently developed scaled exponential linear unit (SELU) as a nonlinear self-normalizing activation function, which for the first time has been applied in medical imaging with CNN. SELU has important advantages such as being parameter-free and mini-batch independent, which may help to overcome memory constraints during training. A dataset with 91 images from 35 patients during Valsalva, contraction, and rest, all labeled by three operators, is used for training and evaluation in a leave-one-patient-out cross validation. Results show a median Dice similarity coefficient of 0.90 with an interquartile range of 0.08, with equivalent performance to the three operators (with a Williams’ index of 1.03), and outperforming a U-Net architecture without the need for batch normalization. We conclude that the proposed fully automatic method achieved equivalent accuracy in segmenting the pelvic floor levator hiatus compared to a previous semiautomatic approach. PMID:29340289

  16. Automatic segmentation method of pelvic floor levator hiatus in ultrasound using a self-normalizing neural network.

    PubMed

    Bonmati, Ester; Hu, Yipeng; Sindhwani, Nikhil; Dietz, Hans Peter; D'hooge, Jan; Barratt, Dean; Deprest, Jan; Vercauteren, Tom

    2018-04-01

    Segmentation of the levator hiatus in ultrasound allows the extraction of biometrics, which are of importance for pelvic floor disorder assessment. We present a fully automatic method using a convolutional neural network (CNN) to outline the levator hiatus in a two-dimensional image extracted from a three-dimensional ultrasound volume. In particular, our method uses a recently developed scaled exponential linear unit (SELU) as a nonlinear self-normalizing activation function, which for the first time has been applied in medical imaging with CNN. SELU has important advantages such as being parameter-free and mini-batch independent, which may help to overcome memory constraints during training. A dataset with 91 images from 35 patients during Valsalva, contraction, and rest, all labeled by three operators, is used for training and evaluation in a leave-one-patient-out cross validation. Results show a median Dice similarity coefficient of 0.90 with an interquartile range of 0.08, with equivalent performance to the three operators (with a Williams' index of 1.03), and outperforming a U-Net architecture without the need for batch normalization. We conclude that the proposed fully automatic method achieved equivalent accuracy in segmenting the pelvic floor levator hiatus compared to a previous semiautomatic approach.

  17. MRI evaluation of the levator ani muscle: anatomic correlations and practical applications.

    PubMed

    Plattner, V; Leborgne, J; Heloury, Y; Cohen, J Y; Rogez, J M; Lehur, P A; Robert, R

    1991-01-01

    A comparative study of serial anatomic sections in the transverse, frontal and sagittal planes with corresponding MRI sections of the pelvis allowed the authors to define the most suitable sectional planes and MRI modes for a morphologic study of the levator ani muscle. This study shows the value of MRI examination in the assessment of anorectal malformations.

  18. [The establishment and meaning of the three-dimensional finite element model of pelvic floor levator ani muscle in an old healthy woman].

    PubMed

    Chen, Wei; Wn, Lijun; Yan, Zhihan; Wang, Jusong; Fu, Yalan; Chen, Xiongfei; Liu, Kun; Wu, Zhipeng

    2011-10-01

    This paper is to establish a three-dimensional finite element model (3D-FEM) of pelvic floor levator ani muscles in an old healthy women. We acquired the image data of the pelvic bones and pelvic floor muscles from CT and MRI scanning in a non-pregnant old healthy female volunteers. The 3-D reconstruction and mesh optimization of the whole pelvic bones and muscles with application of image processing software Mimics12.0 and Geomagic9.0 were obtained. Then we built the 3D-FEM of the musculoskeletal system of the pelvic bones and levator ani muscles with Ansys11.0 software. We obtained an accurate 3D-FEM of pelvic bones and levator ani muscles in the older healthy woman. The results showed that it was reliable to build 3D-FEM with CT and MRI scanning data and this model could vividly reflect the huge space anatomy of the real pelvic floor levator ani muscles. It avoids the defects to gain the model from the body of anatomical specimens in the past. The image data of model are closer to vivisection, and the model is more conducive to the latter finite element analysis.

  19. Reflexive contraction of the levator palpebrae superioris muscle to involuntarily sustain the effective eyelid retraction through the transverse trigeminal proprioceptive nerve on the proximal Mueller's muscle: verification with evoked electromyography.

    PubMed

    Ban, Ryokuya; Matsuo, Kiyoshi; Osada, Yoshiro; Ban, Midori; Yuzuriha, Shunsuke

    2010-01-01

    We have proposed a hypothetical mechanism to involuntarily sustain the effective eyelid retraction, which consists of not only voluntary but also reflexive contractions of the levator palpebrae superior muscle (LPSM). Voluntary contraction of fast-twitch fibres of the LPSM stretches the mechanoreceptors in Mueller's muscle to evoke trigeminal proprioception, which induces continuous reflexive contraction of slow-twitch fibres of the LPSM through the trigeminal proprioceptive nerve fibres innervating the mechanoreceptors in Mueller's muscle via the oculomotor neurons, as a tonic trigemino-oculomotor reflex. In the common skeletal mixed muscles, electrical stimulation of the proprioceptive nerve, which apparently connects the mechanoreceptors in muscle spindles to the motoneurons, induces the electromyographic response as the Hoffmann reflex. To verify the presence of the trigemino-oculomotor reflex, we confirmed whether intra-operative electrical simulation of the transverse trigeminal proprioceptive nerve on the proximal Mueller's muscle evokes an electromyographic response in the LPSM under general anaesthesia in 12 patients. An ipsilateral, phasic, short-latency response (latency: 2.8+/-0.3 ms) was induced in the ipsilateral LPSM in 10 of 12 subjects. As successful induction of the short-latency response in the ipsilateral LPSM corresponds to the Hoffmann reflex in the common skeletal mixed muscles, the present study is the first electromyographic verification of the presence of the monosynaptic trigemino-oculomotor reflex to induce reflexive contraction of the LPSM. The presence of the trigemino-oculomotor reflex may elucidate the unexplainable blepharoptosis due to surgery, trauma and tumour, all of which may damage the trigeminal proprioceptive nerve fibres to impair the trigemino-oculomotor reflex. Copyright (c) 2008. Published by Elsevier Ltd.

  20. Prominent expression of phosphodiesterase 5 in striated muscle of the rat urethra and levator ani.

    PubMed

    Lin, Guiting; Huang, Yun-Ching; Wang, Guifang; Lue, Tom F; Lin, Ching-Shwun

    2010-08-01

    We investigated phosphodiesterase 5 distribution and activity in the urethra. Rat tissues were examined for phosphodiesterase 5 and alpha-smooth muscle actin expression. Urethral phosphodiesterase 5 activity was examined by tissue bath in the presence of sildenafil (Pfizer, New York, New York). Anti-alpha-smooth muscle actin antibody (Abcam) stained all known smooth muscles in all tested tissues and revealed a few smooth muscle fibers in the levator ani muscle. Anti-phosphodiesterase 5 antibody (Abcam) stained smooth muscle in the penis and bladder but not striated leg muscle. However, it stained predominantly striated muscle in the urethra and the levator ani muscle. In the urethra the amount of phosphodiesterase 5 in striated muscle was 6 times that in smooth muscle. In urethral striated muscle phosphodiesterase 5 expression was localized to Z-band striations. Smooth and striated muscle intermingling was clearly visible on the inner and outer rims of the circularly arranged striated muscle layer. Relaxation of precontracted urethral tissues by sodium nitroprusside (Sigma-Aldrich) was enhanced by sildenafil, indicating phosphodiesterase 5 activity, which was primarily located in the striated muscle according to phosphodiesterase 5 staining. Despite its presumed smooth muscle specificity phosphodiesterase 5 was predominantly expressed in the striated muscle of the urethra and in the levator ani muscle. Results are consistent with earlier studies in which these striated muscles were developmentally related to smooth muscle. They also suggest that these striated muscles are possibly regulated by phosphodiesterase 5. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease.

    PubMed

    Tsukada, Yuichiro; Ito, Masaaki; Watanabe, Kentaro; Yamaguchi, Kumiko; Kojima, Motohiro; Hayashi, Ryuichi; Akita, Keiichi; Saito, Norio

    2016-05-01

    Intersphincteric resection has become a widely used treatment for patients with rectal cancer. However, the detailed anatomy of the anal canal related to this procedure has remained unclear. The purpose of this study was to clarify the detailed anatomy of the anal canal. This is a descriptive study. Histologic evaluations of paraffin-embedded tissue specimens were conducted at a tertiary referral hospital. Tissue specimens were obtained from cadavers of 5 adults and from 13 patients who underwent abdominoperineal resection for rectal cancer. Sagittal sections from 9 circumferential portions of the cadaveric anal canal (histologic staining) and 3 circumferential portions from patients were studied (immunohistochemistry for smooth and skeletal muscle fibers). Longitudinal fibers between the internal and external anal sphincters consisted primarily of smooth muscle fibers that continued from the longitudinal muscle of the rectum. The levator ani muscle attached directly to the lateral surface of the longitudinal smooth muscle of the rectum. The length of the attachment was longer in the anterolateral portion and shorter in the posterior portion of the anal canal. In the lateral and posterior portions, the levator ani muscle partially overlapped the external anal sphincter; however, there was less overlap in the anterolateral portion. In the posterior portion, thick smooth muscle was present on the surface of the levator ani muscle and it continued to the longitudinal muscle of the rectum. We observed only limited portions in some surgical specimens because of obstruction by tumors. The levator ani muscle attaches directly to the longitudinal muscle of the rectum. The spatial relationship between the smooth and skeletal muscles differed in different portions of the anal canal. For intersphincteric resection, dissection must be performed between the longitudinal muscle of the rectum and the levator ani muscle/external anal sphincter, and the appropriate surgical lines

  2. Differences in the Biometry of the Levator Hiatus at Rest, During Contraction, and During Valsalva Maneuver Between Women With and Without Provoked Vestibulodynia Assessed by Transperineal Ultrasound Imaging.

    PubMed

    Thibault-Gagnon, Stéphanie; McLean, Linda; Goldfinger, Corrie; Pukall, Caroline; Chamberlain, Susan

    2016-02-01

    Pelvic floor muscle (PFM) involvement is suspected in the pathophysiology of provoked vestibulodynia (PVD); however, the underlying mechanisms are unclear. PFM morphology can be inferred from the biometry of the levator hiatus determined through dynamic ultrasound imaging. The aim of this study was to determine the nature of PFM involvement in women with PVD via an evaluation of the biometry of the levator hiatus at rest, upon maximal voluntary contraction (MVC) of the PFMs, and upon maximal Valsalva maneuver (MVM). Thirty-eight women with PVD and 39 asymptomatic controls were imaged using 3D transperineal ultrasound. Levator hiatal dimensions (area; left-right [LR] and anteroposterior [AP] diameters) were measured at rest, on MVC, and on MVM. Differences in hiatal dimensions and in relative changes in dimensions from rest to MVC and from rest to MVM were compared between groups using separate 1-way analyses of variance for each measure and task. Analysis of covariance models were used to investigate the impact of levator hiatal dimensions at rest on the relative changes in the levator hiatal dimensions during MVC and MVM. Levator hiatal area, LR, and AP diameters, at rest, on MVC, and on MVM were the main outcome measures. Relative changes in hiatal dimensions were assessed as the percent change in hiatal area, LR diameter, and AP diameter. In comparison with controls, women with PVD had smaller hiatal areas at rest, on MVC, and on MVM, concurrent with smaller LR diameters on MVM. Women with PVD had a significantly smaller change in hiatal area on MVM than controls, but no differences were evident on MVC. In both groups, smaller levator hiatal dimensions at rest were associated with smaller relative decreases in dimensions on MVC and larger relative increases in dimensions on MVM. In comparison to controls, women with PVD appear to have narrower levator hiatus' and less capacity to distend their hiatus on Valsalva. The state of the PFMs at rest appears to

  3. Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani.

    PubMed

    Vincent, C

    1999-03-01

    Anal fissures, proctalgia fugax, levator ani syndrome, and pruritus ani are common causes of anorectal pain and irritation. The clinician who obtains a thorough history and performs a complete examination can accurately diagnose these disorders. Ancillary tests seldom are helpful and rarely are necessary. Most patients suffering from these conditions readily respond to conservative therapy provided in the primary care practitioner's office.

  4. A Promising Modified Procedure for Upper Eyelid Retraction-Associated Graves' Ophthalmopathy: Transconjunctival Lateral Levator Aponeurectomy.

    PubMed

    Khatavi, Fatima; Nasrollahi, Kobra; Zandi, Alireza; Panahi, Maryam; Mortazavi, Mahshid; Pourazizi, Mohsen; Ranjbar-Omidi, Behzad

    2017-01-01

    Upper eyelid retraction is a characteristic feature of thyroid eye disease, including Graves' orbitopathy. In this study, a new surgical technique for correction of lid retraction secondary to Graves' orbitopathy is described. Sixteen eyelids of patients older than 18 years old underwent surgical correction for moderate to severe lid retraction secondary to Graves' orbitopathy. In this procedure, levator aponeurectomy was performed via a transconjunctival approach. Upper marginal reflex distance (MRD1) was measured before the surgery and at 1 week, 3 months, and 6 months after the surgery. MRD1 was reduced significantly from preoperatively (mean: 7.84 mm) to 1 week after the surgery (mean: 3.59 mm) (P < 0.001). Three and six months after surgery, mean MRD1 was 5.09 mm and 5.10 mm, respectively, showing that lid retraction was improved significantly (P < 0.001). Lateral levator aponeurectomy via the transconjunctival approach is a simple, scar-less, quick procedure that has optimal stable outcome.

  5. The Relationship of Amount of Resection and Time for Recovery of Bell’s Phenomenon after Levator Resection in Congenital Ptosis

    PubMed Central

    Goel, Ruchi; Kishore, Divya; Nagpal, Smriti; Jain, Sparshi; Agarwal, Tushar

    2017-01-01

    Background: Recovery of Bell`s phenomenon after levator resection is unpredicatable. Delayed recovery can result in vision threatening corneal complications. Aim: To study the variability of Bell’s phenomenon and time taken for its recovery following levator resection for blepharoptosis and to correlate it with the amount of resection. Methods: A prospective observational study was conducted on 32 eyes of 32 patients diagnosed as unilateral simple congenital blepharoptosis who underwent levator resection at a tertiary care center between July 2013 and May 2015. Patients were followed up for 5 months and correction of ptosis, type of Bell`s, duration of Bell`s recovery and complications were noted. Results: The study group ranged from 16-25 years with 15:17 male: female ratio. There were 9 mild, 16 moderate and 7 severe ptosis. Satisfactory correction was achieved in all cases. Good Bell`s recovery occurred in 13 eyes on first post-op day, in 2-14 days in 19 eyes and 28 days in 1 eye. Inverse Bell`s was noted along with lid oedema and ecchymosis in 2 patients. Large resections (23-26mm) were associated with poor Bell`s on the first postoperative day (p=0.027, Fisher`s exact test). However, the duration required for recovery of Bell`s phenomenon did not show any significant difference with the amount of resection. (p=0.248, Mann Whitney test). Larger resections resulted in greater lagophthalmos (correlation=0.830, p<0.0001). Patients with recovery of Bell`s delayed for more than 7 days were associated with greater number of complications (p=0.001 Fisher`s Exact Test). Conclusion: Close monitoring for Bell`s recovery is required following levator resection. PMID:28584563

  6. A new teaching model for demonstrating the movement of the extraocular muscles.

    PubMed

    Iwanaga, Joe; Refsland, Jason; Iovino, Lee; Holley, Gary; Laws, Tyler; Oskouian, Rod J; Tubbs, R Shane

    2017-09-01

    The extraocular muscles consist of the superior, inferior, lateral, and medial rectus muscles and the superior and inferior oblique muscles. This study aimed to create a new teaching model for demonstrating the function of the extraocular muscles. A coronal section of the head was prepared and sutures attached to the levator palpebral superioris muscle and six extraocular muscles. Tension was placed on each muscle from a posterior approach and movement of the eye documented from an anterior view. All movements were clearly seen less than that of the inferior rectus muscle. To our knowledge, this is the first cadaveric teaching model for demonstrating the movements of the extraocular muscles. Clin. Anat. 30:733-735, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  7. Reliability of levator scapulae index in subjects with and without scapular downward rotation syndrome.

    PubMed

    Lee, Ji-Hyun; Cynn, Heon-Seock; Choi, Woo-Jeong; Jeong, Hyo-Jung; Yoon, Tae-Lim

    2016-05-01

    The objective of this study was to introduce levator scapulae (LS) measurement using a caliper and the levator scapulae index (LSI) and to investigate intra- and interrater reliability of the LSI in subjects with and without scapular downward rotation syndrome (SDRS). Two raters measured LS length twice in 38 subjects (19 with SDRS and 19 without SDRS). For reliability testing, intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. Intrarater reliability analysis resulted with ICCs ranging from 0.94 to 0.98 in subjects with SDRS and 0.96 to 0.98 in subjects without SDRS. These results represented that intrarater reliability in both groups were excellent for measuring LS length with the LSI. Interrater reliability was good (ICC: 0.82) in subjects with SDRS; however, interrater reliability was moderate (ICC: 0.75) in subjects without SDRS. Additionally, SEM and MDC were 0.13% and 0.36% in subjects with SDRS and 0.35% and 0.97% in subjects without SDRS. In subjects with SDRS, low dispersion of the measurement errors and MDC were shown. This study suggested that the LSI is a reliable method to measure LS length and is more reliable for subjects with SDRS. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Imagine no religion: Heretical disgust, anger and the symbolic purity of mind.

    PubMed

    Ritter, Ryan S; Preston, Jesse L; Salomon, Erika; Relihan-Johnson, Daniel

    2016-01-01

    Immoral actions, including physical/sexual (e.g., incest) and social (e.g., unfairness) taboos, are often described as disgusting. But what about immoral thoughts, more specifically, thoughts that violate religious beliefs? Do heretical thoughts taint the purity of mind? The present research examined heretical disgust using self-report measures and facial electromyography. Religious thought violations consistently elicited both self-reported disgust and anger. Feelings of disgust also predicted harsh moral judgement, independent of anger, and were mediated by feelings of "contamination". However, religious thought violations were not associated with a disgust facial expression (i.e., levator labii muscle activity) that was elicited by physically disgusting stimuli. We conclude that people (especially more religious people) do feel disgust in response to heretical thoughts that is meaningfully distinct from anger as a moral emotion. However, heretical disgust is not embodied in a physical disgust response. Rather, disgust has a symbolic moral value that marks heretical thoughts as harmful and aversive.

  9. Stretching position can affect levator scapular muscle activity, length, and cervical range of motion in people with a shortened levator scapulae.

    PubMed

    Jeong, Hyo-Jung; Cynn, Heon-Seock; Yi, Chung-Hwi; Yoon, Jang-Whon; Lee, Ji-Hyun; Yoon, Tae-Lim; Kim, Bo-Been

    2017-07-01

    Levator scapulae (LS) muscle stretching exercises are a common method of lengthening a shortened muscle; however, the appropriate stretching position for lengthening the LS in people with a shortened LS remains unclear. The purpose of this study was to compare the effects of different stretching exercise positions on the LS and introduce effective stretching exercise methods to clinicians. Twenty-four university students (12 men, 12 women) with a shortened LS were recruited. LS muscle activity, LS index (LSI), and cervical range of motion (ROM) were measured pre (baseline) and post three different stretching exercise positions (sitting, quadruped, and prone). The LSI and cervical ROM exceeded the minimal detectable change and had significant changes. The LSI was greater in the sitting position than at the baseline (p = 0.01), quadruped position (p < 0.01); the LSI in the prone position presented a higher increase than the quadruped position (p = 0.01). The cervical ROM increased in the sitting position when compared to the baseline (p < 0.01) and quadruped position (p < 0.01). Stretching the LS in the sitting position was the most effective exercise for improving LS muscle length and cervical ROM. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Levator claviculae muscle discovered during physical examination for cervical lymphadenopathy.

    PubMed

    Rosenheimer, J L; Loewy, J; Lozanoff, S

    2000-01-01

    During a routine physical examination of an adult female with a history of breast cancer and cervical lymphadenopathy, a mass was noted in the right supraclavicular region. The mass was unilateral and easily palpable along the superior border near the median aspect of the clavicle. Plain film radiography, performed to determine whether the mass represented an enlarged jugulo-omohyoid lymph node, revealed an elongated opaque mass in this region. Computed tomographic (CT) and magnetic resonance (MR) images were subsequently obtained. Sequential axial CT scans revealed a cylindrical mass that appeared to be independent of contiguous muscles, including the sternocleidomastoid, anterior, and middle scalene muscles. This mass attached inferiorly to the clavicle and superiorly to the transverse process of the sixth cervical vertebra. Sagittal, coronal, and axial MR scans confirmed the presence of a well-defined superficial mass. It is concluded that the mass represents a levator claviculae (cleidocervical) muscle. This observation underscores the importance of understanding soft tissue variants that may be encountered during a routine physical examination. Copyright 2000 Wiley-Liss, Inc.

  11. Optimal Normalization Tests for Muscle Activation of the Levator Scapulae, Pectoralis Minor, and Rhomboid Major: An Electromyography Study Using Maximum Voluntary Isometric Contractions.

    PubMed

    Castelein, Birgit; Cagnie, Barbara; Parlevliet, Thierry; Danneels, Lieven; Cools, Ann

    2015-10-01

    To identify maximum voluntary isometric contraction (MVIC) test positions for the deeper-lying scapulothoracic muscles (ie, levator scapulae, pectoralis minor, rhomboid major), and to provide a standard set of a limited number of test positions that generate an MVIC in all scapulothoracic muscles. Cross-sectional study. Physical and rehabilitation medicine department. Healthy subjects (N=21). Not applicable. Mean peak electromyographic activity from levator scapulae, pectoralis minor, and rhomboid major (investigated with fine-wire electromyography) and from upper trapezius, middle trapezius, lower trapezius, and serratus anterior (investigated with surface electromyography) during the performance of 12 different MVICs. The results indicated that various test positions generated similar high mean electromyographic activity and that no single test generated maximum activity for a specific muscle in all subjects. The results of this study support using a series of test positions for normalization procedures rather than a single exercise to increase the likelihood of recruiting the highest activity in the scapulothoracic muscles. A standard set of 5 test positions was identified as being sufficient for generating an MVIC of all scapulothoracic muscles: seated T, seated U 135°, prone T-thumbs up, prone V-thumbs up, and supine V-thumbs up. A standard set of test positions for normalization of scapulothoracic electromyographic data that also incorporates the levator scapulae, pectoralis minor, and rhomboid major muscles is 1 step toward a more comprehensive understanding of normal and abnormal muscle function of these muscles and will help to standardize the presentation of scapulothoracic electromyographic muscle activity. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. [Sonographic evaluation of the levator ani muscle in women with stress urinary incontinence].

    PubMed

    Stachowicz, Norbert; Stachowicz, Sylwia; Smoleń, Agata; Morawska, Dorota; Kotarski, Jan

    2012-09-01

    Three-dimensional sonography has been used for about 15 years, not only to examine the female genital organs, but also the lower urinary tract and pelvic floor. Three-dimensional sonography offers more information than traditional two-dimensional sonography allowing for a dynamic representation of the examined structures and observation at any angle necessary. Translabial sonography is the best way of a sonographic examination of the lower urinary tract, because it does not affect the mutual relationship of any parts in the lower pelvic area, contrary to the transrectal or transvaginal probes. In order to establish proper treatment of the urinary incontinence symptoms, not only a functional examination of the lower urinary tract, but also a very accurate assessment of the statics of the female genital organs and pelvic floor need to be performed. The aim of the study was to rate the area and diameters of the limbs of the levator ani muscle using a three-dimensional (3D) translabial sonography in women with stress urinary incontinence without the female genital tract prolapse. The study group included 100 patients who were examined with the GE Kretz Voluson 730 (GE, Austria), equipped with 6-9 MHz translabial probe. The first group with stress urinary incontinence consisted of 50 women (mean age 56.22 (+/- 10.43) years) and the second group included 50 women without symptoms (mean age 49.40 (+/- 13.22) years). All cases of urinary stress incontinence in the first group were confirm by means of a urodynamic examination. Women in both groups had similar body weight (kilograms), mean (+/- SD): 26.88 (+/- 2.02) and 26.20 (+/- 4,14), respectively. Menopausal status in both groups was not statistically significant and amounted to 7.21 (+/- 8.71) in the group of women with stress urinary incontinence and 4.70 (+/- 6.32) in the group without symptoms. Mean (+/- SD) number of deliveries was significantly higher in the group of women with stress urinary incontinence than in

  13. [Magnetic resonance imaging features in two Chinese family with congenital fibrosis of extraocular muscles].

    PubMed

    Wu, Li; Zhou, Lian-Hong; Liu, Chang-Sheng; Cha, Yun-Fei; Wang, Jiong; Xing, Yi-Qiao

    2009-11-01

    The aim of this article was to investigate the structural basis of ocular motility and visual abnormalities in humans with congenital fibrosis of the extraocular muscles (CFEOM). 17 volunteers from 2 CFEOM pedigrees Clinical ophthalmic and motility examed and 18 normal control subjects were correlated with thin-sectioned magnetic resonance imaging (MRI) across the orbit and the brain-stem level. Subjects with CFEOM had severe bilateral blepharoptosis, limited supraduction, and variable ophthalmoplegia. In affected subjects, MRI demonstrated atrophy of the levator palpebrae superioris, all EOMs, and the optic nerves, and small or absent orbital motor nerves. The oculomotor nerve was most severely hypoplastic, but the abducens was also affected. Subjects with CFEOM exhibited subclinical but highly significant reduction from normal in mean optic nerve size (P < 0.05). There are also some difference between the two CFEOM pedigrees. These findings suggest that neuronal disease is primary in CFEOM, with myopathy arising secondary to abnormal innervation and the oculomotor nucleus and trochlear nucleus of the abnormalities defects.

  14. Vaginismus and dyspareunia: automatic vs. deliberate disgust responsivity.

    PubMed

    Borg, Charmaine; de Jong, Peter J; Schultz, Willibrord Weijmar

    2010-06-01

    The difficulty of penetration experienced in vaginismus and dyspareunia may at least partly be due to a disgust-induced defensive response. To examine if sex stimuli specifically elicit: (i) automatic disgust-related memory associations; (ii) physiological disgust responsivity; and/or (iii) deliberate expression of disgust/threat. Two single target Implicit Association Task (st-IAT) and electromyography (EMG) were conducted on three groups: vaginismus (N = 24), dyspareunia (N = 24), and control (N = 31) group. st-IAT, to index their initial disgust-related associations and facial EMG for the m. levator labii and m. corrugator supercilii regions. Both clinical groups showed enhanced automatic sex-disgust associations. As a unique physiological expression of disgust, the levator activity was specifically enhanced for the vaginismus group, when exposed to a women-friendly SEX video clip. Also at the deliberate level, specifically the vaginismus group showed enhanced subjective disgust toward SEX pictures and the SEX clip, along with higher threat responses. Supporting the view that disgust is involved in vaginismus and dyspareunia, for both, clinical groups' sex stimuli automatically elicited associations with disgust. Particularly for the vaginismus group, these initial disgust associations persisted during subsequent validation processes and were also evident at the level of facial expression and self-report data. Findings are consistent with the notion that uncontrollable activated associations are involved in eliciting defensive reactions at the prospect of penetration seen in both conditions. Whereas deliberate attitudes, usually linked with the desire for having intercourse, possibly generate the distinction (e.g., severity) between these two conditions.

  15. The Urethral Rhabdosphincter, Levator Ani Muscle, and Perineal Membrane: A Review

    PubMed Central

    Hinata, Nobuyuki; Murakami, Gen

    2014-01-01

    Detailed knowledge of the anatomy of the rhabdosphincter and adjacent tissues is mandatory during urologic surgery to ensure reliable oncologic and functional outcomes. To characterize the levator ani (LA) function for the urethral sphincter, we described connective tissue morphology between the LA and urethral rhabdosphincter. The interface tissue between the LA and rhabdosphincter area in males contained abundant irregularly arrayed elastic fibers and smooth muscles. The male rhabdosphincter was positioned alongside the LA to divide the elevation force and not in-series along the axis of LA contraction. The male perineal membrane was thin but solid and extends along the inferior margin or bottom of the rhabdosphincter area. In contrast, the female rhabdosphincter, including the compressor urethrae and urethrovaginal sphincter muscles, was embedded in the elastic fiber mesh that is continuous with the thick, multilaminar perineal membrane. The inferomedial edge of the female LA was attached to the upper surface of the perineal membrane and not directly attached to the rhabdosphincter. We presented new diagrams showing the gender differences in topographical anatomy of the LA and rhabdosphincter. PMID:24877147

  16. Musculo-nasomucosal unit with complete lateral bony freeing and medial rotation for ideal C-shape restoration and retropositioning of the levator veli palatini.

    PubMed

    El-Shazly, Mohamed

    2012-11-01

    No definitive procedure for cleft repair has been identified yet as the gold standard. Accordingly, this work tried to appraise the hypothesis that if the bony detachment and full retropositioning of the levator veli palatini muscle can ideally present an anatomical C-shape muscular sling restoration and if this is accompanied with pushback palatoplasty, would this present a better result in terms of tissue fistulation and phonetic impairment? A series of 74 different degrees of palatal clefts were operated by pushback palatoplasty combined with a modified approach of the levator vili palatini. This muscle was dissected only from the oral mucosa while kept attached to the nasal one as a musculo-nasomucosal unit. This unit was completely detached from the bony margin of the hard palate and then medially rotated and retropositioned in a typical C-shape mobile sling. Evaluations included suture line assessment and fistula development, and following the child's need for speech therapy. There were no intraoperative complications. Definite anterior fistulae with nasal air and foot leakage were observed in 2 cases. Four cases had postoperative velopharyngeal incompetence with a need for speech therapy. Tension-free closure, lower risk of fistula, good restoration of velopharyngeal functions, ability to be performed on all cleft types, ability to provide a good intraoperative exposure, and being a single stage seem to be the most important advantages of this unpublished technique.

  17. Levator alae nasi muscle V-Y island flap for nasal tip reconstruction.

    PubMed

    La Padula, Simone; Abbate, Vincenzo; Di Monta, Gianluca; Schonauer, Fabrizio

    2017-03-01

    Nasal tip reconstruction can be very challenging. It requires close attention to skin texture, colour and thickness matching, with the respect of the nasal aesthetic units and symmetry. Flaps are usually preferred to skin grafts where possible. Based on different donor areas, various flaps have been described for reconstruction of this region. Here we present a new V-Y myocutaneous island flap based on the levator alae nasi muscle (LAN muscle) blood supply. This flap may represent an alternative to the nasalis myocutaneous sliding V-Y flap previously described by Rybka. As its pivot point it is located more cranially than the nasalis flap, and it can advance more medially than the Rybka flap, with the possibility of covering larger defects of the nasal tip area, up to 1.8 cm in diameter. Over the past 5 years, 24 patients received nasal tip reconstruction with this flap following the resection of basal cell carcinomas. Good tip projection was maintained, and the aesthetic outcome was satisfactory, with well healed scars. We recommend this technique as an alternative to other flaps for nasal tip defects, especially if paramedian. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Testosterone-induced development of the rat levator ani muscle.

    PubMed

    Tobin, C; Joubert, Y

    1991-07-01

    The perinatal development of the levator ani (LA) muscle in male and female rats was investigated by measuring the total number of muscle units (MU) (i.e., mononucleate cells, clustered or independent myotubes, and muscle fibers) in transverse semithin sections of the entire muscle and the MU cross-sectional area in 22-day-old fetuses (F22), 1-day-old (D1 = day of birth), 3-day-old (D3), and 6-day-old (D6) newborns. Male muscle contained 350 +/- 64 MU on F22, twice that of the female. The number of MU increased markedly in males from F22, but changed little in females; the number of MU in males was 760% that of females on D6. The MU cross-sectional area was greater in males on F22 (120.8 micron(s)2 +/- 7.5) and D1 (155.2 micron(s)2 +/- 64.8) than in females (F22: 89.2 micron(s) +/- 14.2, D1: 64.1 micron(s)2 +/- 19.7) and dropped to about 30 X micron(s)2 in both sexes on D6. Female rats given a single injection of testosterone propionate (TP) before D7 showed a significant increase in the number of fibers, but no increase in cross-sectional area. TP given after D7 had no effect on the fiber number, but increased the average cross-sectional area. The increase in fiber number induced by postnatal TP treatment was a permanent effect, still quantifiable in 15-month-old females. We conclude that the sexual dimorphism of the rat LA muscle is principally due to a dramatic increase in the MU number in male muscles during the perinatal period, rather than to involution of the fibers in female muscles as it is widely accepted. This increase seems to be, at least partly, under the control of testosterone.

  19. [Irritable bowel syndrome, levator ani syndrome, proctalgia fugax and chronic pelvic and perineal pain].

    PubMed

    Watier, Alain; Rigaud, Jérôme; Labat, Jean-Jacques

    2010-11-01

    To define functional gastrointestinal pain, irritable bowel syndrome (IBS), levator ani syndrome, proctalgia fugax, the pathophysiology of these syndromes and the treatments that can be proposed. Review of articles published on the theme based on a Medline (PubMed) search and consensus conferences selected according to their scientific relevance. IBS is very common. Patients report abdominal pain and/or discomfort, bloating, and abnormal bowel habit (diarrhoea, constipation or both), in the absence of any structural or biochemical abnormalities. IBS has a complex, multifactorial pathophysiology, involving biological and psychosocial interactions resulting in dysregulation of the brain-gut axis associated with disorders of intestinal motility, hyperalgesia, immune disorders and disorders of the intestinal bacterial microflora and autonomic and hormonal dysfunction. Many treatments have been proposed, ranging from diet to pharmacology and psychotherapy. Patients with various types of chronic pelvic and perineal pain, especially those seen in urology departments, very often report associated IBS. This syndrome is also part of a global and integrated concept of pelviperineal dysfunction, avoiding a rigorous distinction between the posterior segment and the midline and anterior segments of the perineum. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  20. Is levator hiatus distension associated with peripheral ligamentous laxity during pregnancy?

    PubMed

    Gachon, Bertrand; Fritel, Xavier; Fradet, Laetitia; Decatoire, Arnaud; Lacouture, Patrick; Panjo, Henri; Pierre, Fabrice; Desseauve, David

    2017-08-01

    The impact of pregnancy on pelvic floor disorders remains poorly understood. During pregnancy, an increase in ligamentous laxity and pelvic organ mobility is often reported. Our main objective was to investigate a possible association between peripheral ligamentous laxity and levator hiatus (LH) distension during pregnancy. This was a prospective longitudinal study of 26 pregnant women followed up from the first to the third trimester. We collected the following information: occurrence of pelvic organ prolapse (POP) symptoms (score higher than 0 for the POP section of the Pelvic Floor Distress Inventory 20 questions score), 4D perineal ultrasound scan results with LH distension assessment and measurement of metacarpophalangeal joint mobility (MCP laxity). The association between MCP laxity and LH distension was estimated by mixed multilevel linear regression. The associations between MCP laxity and categorical parameters were estimated in a multivariate analysis using a generalized estimating equation model. MCP laxity and LH distension were correlated with a correlation coefficient of 0.26 (p = 0.02), and 6.8% of the LH distension variance was explained by MCP laxity. In the multivariate analysis, MCP laxity was associated with POP symptoms with an odds ratio at 1.05 (95% CI 1.01-1.11) for an increase of 1° in MCP laxity. LH distension and peripheral ligamentous laxity are significantly associated during pregnancy. However, the relationship is weak, and the results need to be confirmed in larger populations and with more specific techniques such as elastography to directly assess the elastic properties of the pelvic floor muscles.

  1. Testing the disgust conditioning theory of food-avoidance in adolescents with recent onset anorexia nervosa.

    PubMed

    Hildebrandt, Tom; Grotzinger, Andrew; Reddan, Marianne; Greif, Rebecca; Levy, Ifat; Goodman, Wayne; Schiller, Daniela

    2015-08-01

    Anorexia nervosa is characterized by chronic food avoidance that is resistant to change. Disgust conditioning offers one potential unexplored mechanism for explaining this behavioral disturbance because of its specific role in facilitating food avoidance in adaptive situations. A food based reversal learning paradigm was used to study response flexibility in 14 adolescent females with restricting subtype anorexia nervosa (AN-R) and 15 healthy control (HC) participants. Expectancy ratings were coded as a behavioral measure of flexibility and electromyography recordings from the levator labii (disgust), zygomaticus major (pleasure), and corrugator (general negative affect) provided psychophysiological measures of emotion. Response inflexibility was higher for participants with AN-R, as evidenced by lower extinction and updated expectancy ratings during reversal. EMG responses to food stimuli were predictive of both extinction and new learning. Among AN-R patients, disgust specific responses to food were associated with impaired extinction, as were elevated pleasure responses to the cued absence of food. Disgust conditioning appears to influence food learning in acutely ill patients with AN-R and may be maintained by counter-regulatory acquisition of a pleasure response to food avoidance and an aversive response to food presence. Developing strategies to target disgust may improve existing interventions for patients with AN. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy

    PubMed Central

    Houston, Kevin E.; Tomasi, Matteo; Amaral, Christina; Finch, Nicole; Yoon, Michael K.; Lee, Hang; Paschalis, Eleftherios I.

    2018-01-01

    Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance First group data in patients showing successful reanimation of the eyelid with magnetic force. PMID:29367892

  3. [Treatment of eyelid retraction in Grave's disease by recession of the levator complex].

    PubMed

    Fichter, N; Schittkowski, M; Guthoff, R F

    2004-11-01

    The chronic stage in Grave's orbitopathy is characterised by fibrotic changes within the orbital soft tissues, especially the extraocular muscles. Retraction of the eyelids is a common clinical feature of this phenomenon. To solve this problem several techniques for lengthening the upper eyelid have been described with variable rates of success. In this report we describe our modified Harvey's technique for the correction of upper eyelid retraction which includes a complete recession of the Muller's muscle/levator complex from the tarsal plate without the interposition of a spacer. Finally only the skin and the superficial orbicularis muscle are sutured. We also report about our results with this procedure. 8 patients (1 male, 7 female) with lid retraction in Grave's ophthalmopathy were recorded who had undergone the modified lengthening technique by an external approach between 2001 and 2004. Four patients underwent a bilateral procedure and 1 patient showed a significant under-correction, necessitating reoperation. So a total of 13 procedures were included in this follow-up study. Beside the common ophthalmological examination, special interest was put in the difference of the two eyelid apertures in primary position pre- and postoperatively. Within a follow-up period of at least 3 months we recorded an averaged lengthening of the upper eyelid of 3.1 mm. The difference of the two eyelid apertures in primary position improved from 2.2 mm preoperatively to 1.0 mm postoperatively. Only 1 patient needed reoperation because of a significant under-correction. There were no late over-corrections observed. The modified Harvey's technique to lengthen the upper eyelid is a safe and effective method to reduce upper eyelid retraction in Grave's disease. An eventually required orbital decompression or extraocular muscle surgery has to be done before the lid surgery.

  4. Abnormal expression of p27kip1 protein in levator ani muscle of aging women with pelvic floor disorders – a relationship to the cellular differentiation and degeneration

    PubMed Central

    Bukovsky, Antonin; Copas, Pleas; Caudle, Michael R; Cekanova, Maria; Dassanayake, Tamara; Asbury, Bridgett; Van Meter, Stuart E; Elder, Robert F; Brown, Jeffrey B; Cross, Stephanie B

    2001-01-01

    Background Pelvic floor disorders affect almost 50% of aging women. An important role in the pelvic floor support belongs to the levator ani muscle. The p27/kip1 (p27) protein, multifunctional cyclin-dependent kinase inhibitor, shows changing expression in differentiating skeletal muscle cells during development, and relatively high levels of p27 RNA were detected in the normal human skeletal muscles. Methods Biopsy samples of levator ani muscle were obtained from 22 symptomatic patients with stress urinary incontinence, pelvic organ prolapse, and overlaps (age range 38–74), and nine asymptomatic women (age 31–49). Cryostat sections were investigated for p27 protein expression and type I (slow twitch) and type II (fast twitch) fibers. Results All fibers exhibited strong plasma membrane (and nuclear) p27 protein expression. cytoplasmic p27 expression was virtually absent in asymptomatic women. In perimenopausal symptomatic patients (ages 38–55), muscle fibers showed hypertrophy and moderate cytoplasmic p27 staining accompanied by diminution of type II fibers. Older symptomatic patients (ages 57–74) showed cytoplasmic p27 overexpression accompanied by shrinking, cytoplasmic vacuolization and fragmentation of muscle cells. The plasma membrane and cytoplasmic p27 expression was not unique to the muscle cells. Under certain circumstances, it was also detected in other cell types (epithelium of ectocervix and luteal cells). Conclusions This is the first report on the unusual (plasma membrane and cytoplasmic) expression of p27 protein in normal and abnormal human striated muscle cells in vivo. Our data indicate that pelvic floor disorders are in perimenopausal patients associated with an appearance of moderate cytoplasmic p27 expression, accompanying hypertrophy and transition of type II into type I fibers. The patients in advanced postmenopause show shrinking and fragmentation of muscle fibers associated with strong cytoplasmic p27 expression. PMID:11696252

  5. Finite element model focused on stress distribution in the levator ani muscle during vaginal delivery.

    PubMed

    Krofta, Ladislav; Havelková, Linda; Urbánková, Iva; Krčmář, Michal; Hynčík, Luděk; Feyereisl, Jaroslav

    2017-02-01

    During vaginal delivery, the levator ani muscle (LAM) undergoes severe deformation. This stress can lead to stretch-related LAM injuries. The objective of this study was to develop a sophisticated MRI-based model to simulate changes in the LAM during vaginal delivery. A 3D finite element model of the female pelvic floor and fetal head was developed. The model geometry was based on MRI data from a nulliparous woman and 1-day-old neonate. Material parameters were estimated using uniaxial test data from the literature and by least-square minimization method. The boundary conditions reflected all anatomical constraints and supports. A simulation of vaginal delivery with regard to the cardinal movements of labor was then performed. The mean stress values in the iliococcygeus portion of the LAM during fetal head extension were 4.91-7.93 MPa. The highest stress values were induced in the pubovisceral and puborectal LAM portions (mean 27.46 MPa) at the outset of fetal head extension. The last LAM subdivision engaged in the changes in stress was the posteromedial section of the puborectal muscle. The mean stress values were 16.89 MPa at the end of fetal head extension. The LAM was elongated by nearly 2.5 times from its initial resting position. The cardinal movements of labor significantly affect the subsequent heterogeneous stress distribution in the LAM. The absolute stress values were highest in portions of the muscle that arise from the pubic bone. These areas are at the highest risk for muscle injuries with long-term complications.

  6. Morphological and molecular comparisons between tibialis anterior muscle and levator veli palatini muscle: A preliminary study on their augmentation potential.

    PubMed

    Cheng, Xu; Song, Lei; Lan, Min; Shi, Bing; Li, Jingtao

    2018-01-01

    Tibialis anterior (TA) muscle and other somite-derived limb muscles remain the prototype in skeletal muscle study. The majority of head muscles, however, develop from branchial arches and maintain a number of heterogeneities in comparison with their limb counterparts. Levator veli palatini (LVP) muscle is a deep-located head muscle responsible for breathing, swallowing and speech, and is central to cleft palate surgery, yet lacks morphological and molecular investigation. In the present study, multiscale in vivo analyses were performed to compare TA and LVP muscle in terms of their myofiber composition, in-situ stem cell population and augmentation potential. TA muscle was identified to be primarily composed of type 2B myofibers while LVP muscle primarily consisted of type 2A and 2X myofibers. In addition, LVP muscle maintained a higher percentage of centrally-nucleated myofibers and a greater population of satellite cells. Notably, TA and LVP muscle responded to exogenous Wnt7a stimulus in different ways. Three weeks after Wnt7a administration, TA muscle exhibited an increase in myofiber number and a decrease in myofiber size, while LVP muscle demonstrated no significant changes in myofiber number or myofiber size. These results suggested that LVP muscle exhibits obvious differences in comparison with TA muscle. Therefore, knowledge acquired from TA muscle studies requires further testing before being applied to LVP muscle.

  7. Macaque Pontine Omnipause Neurons Play No Direct Role in the Generation of Eye Blinks

    PubMed Central

    Schultz, K. P.; Williams, C. R.

    2010-01-01

    We recorded the activity of pontine omnipause neurons (OPNs) in two macaques during saccadic eye movements and blinks. As previously reported, we found that OPNs fire tonically during fixation and pause about 15 ms before a saccadic eye movement. In contrast, for blinks elicited by air puffs, the OPNs paused <2 ms before the onset of the blink. Thus the burst in the agonist orbicularis oculi motoneurons (OOMNs) and the pause in the antagonist levator palpabrae superioris motoneurons (LPSMNs) necessarily precede the OPN pause. For spontaneous blinks there was no correlation between blink and pause onsets. In addition, the OPN pause continued for 40–60 ms after the time of the maximum downward closing of the eyelids, which occurs around the end of the OOMN burst of firing. LPSMN activity is not responsible for terminating the OPN pause because OPN resumption was very rapid, whereas the resumption of LPSMN firing during the reopening phase is gradual. OPN pause onset does not directly control blink onset, nor does pause offset control or encode the transition between the end of the OOMN firing and the resumption of the LPSMNs. The onset of the blink-related eye transients preceded both blink and OPN pause onsets. Therefore they initiated while the saccadic short-lead burst neurons were still fully inhibited by the OPNs and cannot be saccadic in origin. The abrupt dynamic change of the vertical eye transients from an oscillatory behavior to a single time constant exponential drift predicted the resumption of the OPNs. PMID:20164389

  8. Correlation between extraocular muscle size and motility restriction in thyroid eye disease.

    PubMed

    Dagi, Lora R; Zoumalan, Christopher I; Konrad, Hindola; Trokel, Stephen L; Kazim, Michael

    2011-01-01

    Evaluate the relationship between extraocular muscle (EOM) size, measured by computed tomography, and ocular motility in thyroid eye disease (TED). This case series is based on a retrospective review of the records of 54 patients (108 orbits) with TED. Main outcome measures included EOM size and degree of motility restriction. The average diameter of each rectus muscle was compared with published norms. Four subpopulations based on Age (< 40 or ≥ 40 years) and State of thyroid eye disease (active or stable) were studied. Versions were measured by the corneal light reflex method. The trend of muscle diameter versus motility restriction was evaluated. The average EOM diameter was greater than the norm in the study cohort and 4 subpopulations. The average diameter was largest in the Older and Active TED subpopulations. The inferior rectus and medial rectus were most frequently restricted in the study cohort and 4 subpopulations. The medial rectus had the strongest trend between increasing diameter and motility restriction, followed by the inferior rectus and the superior muscle group (comprised of the superior rectus and levator palpebrae superioris). However, there was a general lack of strong correlation between the diameter of the rectus muscles and their respective motility, especially in the Younger subpopulation. EOM diameters are larger and have more restricted motility in the Older and Active TED subpopulations. Contrary to prior publications, the correlation between EOM diameters and motility was weak, especially in the Younger subpopulation. These findings suggest that the pathophysiology of EOM enlargement is different based upon the age of the patient and the activity of the orbitopathy.

  9. Nasal Base Retraction: A Treatment Algorithm.

    PubMed

    Tas, Süleyman; Colakoglu, Salih; Lee, Bernard Travis

    2017-06-01

    Nasal base retraction results from cephalic malposition of the alar base in the vertical plane, which causes disharmony of the alar base with the rest of the nose structures. Correcting nasal base retraction is very important for improved aesthetic outcomes; however, there is a limited body of literature about this deformity and its treatment. Create a nasal base retraction treatment algorithm based on a severity classification system. This is a retrospective case review study of 53 patients who underwent rhinoplasty with correction of alar base retraction by the senior author (S.T.). The minimum follow-up time was 6 months. Levator labii alaque nasi muscle dissection or alar base release with or without a rim graft on the effected side were performed based on the severity of the alar base retraction. Aesthetic results were assessed with objective grading of preoperative and postoperative patient photographs by two independent plastic surgeons. Functional improvement was assessed with patient self-evaluations of nasal patency. Also, a rhinoplasty outcomes evaluation (ROE) questionnaire was distributed to patients. Comparison of preoperative and postoperative photographs demonstrated that nasal base asymmetry was significantly improved in all cases, and 85% of the patients had complete symmetry. Nasal obstruction was also significantly reduced after surgery (P < 0.001). The majority of patients reported satisfaction (92.5%), with an ROE total score greater than or equal to 20. New techniques and a treatment algorithm for correcting nasal base retraction deformities that will help rhinoplasty surgeons obtain aesthetically and functionally pleasing outcomes for patients. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  10. Nonallergic Eyelid Edema After Botulinum Toxin Type A Injection: Case Report and Review of Literature.

    PubMed

    Chang, Yin-Shuo; Chang, Chang-Cheng; Shen, Jen-Hsiang; Chen, Yu-Tsung; Chan, Karen Kar-Wun

    2015-09-01

    Periocular botulinum toxin type A (BoNTA) injections are generally safe. Ptosis is the most common adverse effect, whereas eyelid edema is rarely reported. There is no consensus on the latter's incidence, clinical course, or treatment strategy. Here we managed a 59-year-old woman who received BoNTA injections to her forehead, glabella, and eye corner. At 3-day follow-up, she presented with painless, nonpruritic, bilateral periorbital edema, and erythema. Preliminary diagnosis was a local allergic reaction, and topical corticosteroid was administered, but upon lack of improvement, edema secondary to venous and lymphatic congestion was hypothesized, and she was advised to apply hot pads over her eyes, blink frequently, and massage the area. Her eyelid edema resolved 2 weeks later. At 4-month follow-up, the patient requested and received another course of BoNTA at half the dose. Frequent blinking was instructed, and the patient reported a satisfactory outcome with no adverse effects. In our literature review, incidence of BoNTA-induced eyelid edema was 1.4% and showed Asian tendency. Although rare, BoNTA-induced periorbital edema is self-limiting, and normally resolves in 2 to 4 weeks without medical treatment. Patients at risk for edema, including Asian ethnicity, dermatochalasis, and poor periocular muscle tone, are advised to receive injections at half the dosage. Examination of the function and tone of the orbicularis oculi and levator palpebrae superioris muscles before treatment is recommended, and application of hot pads over the eyes, frequent blinking in the morning, and self-massage of the affected area to increase venous return have demonstrated to improve outcome.

  11. Nonallergic Eyelid Edema After Botulinum Toxin Type A Injection

    PubMed Central

    Chang, Yin-Shuo; Chang, Chang-Cheng; Shen, Jen-Hsiang; Chen, Yu-Tsung; Chan, Karen Kar-Wun

    2015-01-01

    Abstract Periocular botulinum toxin type A (BoNTA) injections are generally safe. Ptosis is the most common adverse effect, whereas eyelid edema is rarely reported. There is no consensus on the latter's incidence, clinical course, or treatment strategy. Here we managed a 59-year-old woman who received BoNTA injections to her forehead, glabella, and eye corner. At 3-day follow-up, she presented with painless, nonpruritic, bilateral periorbital edema, and erythema. Preliminary diagnosis was a local allergic reaction, and topical corticosteroid was administered, but upon lack of improvement, edema secondary to venous and lymphatic congestion was hypothesized, and she was advised to apply hot pads over her eyes, blink frequently, and massage the area. Her eyelid edema resolved 2 weeks later. At 4-month follow-up, the patient requested and received another course of BoNTA at half the dose. Frequent blinking was instructed, and the patient reported a satisfactory outcome with no adverse effects. In our literature review, incidence of BoNTA-induced eyelid edema was 1.4% and showed Asian tendency. Although rare, BoNTA-induced periorbital edema is self-limiting, and normally resolves in 2 to 4 weeks without medical treatment. Patients at risk for edema, including Asian ethnicity, dermatochalasis, and poor periocular muscle tone, are advised to receive injections at half the dosage. Examination of the function and tone of the orbicularis oculi and levator palpebrae superioris muscles before treatment is recommended, and application of hot pads over the eyes, frequent blinking in the morning, and self-massage of the affected area to increase venous return have demonstrated to improve outcome. PMID:26402825

  12. Levator Syndrome

    MedlinePlus

    ... Pill Identifier Commonly searched drugs Aspirin Metformin Warfarin Tramadol Lactulose Ranitidine News & Commentary Recent News Afib and Weight AHA: Using Electricity to Test Your Risk for Heart Failure Close Siblings Can Ease the Pain of Family Conflict Don't Turn Into a ...

  13. Agreement and reliability of pelvic floor measurements during contraction using three-dimensional pelvic floor ultrasound and virtual reality.

    PubMed

    Speksnijder, L; Rousian, M; Steegers, E A P; Van Der Spek, P J; Koning, A H J; Steensma, A B

    2012-07-01

    Virtual reality is a novel method of visualizing ultrasound data with the perception of depth and offers possibilities for measuring non-planar structures. The levator ani hiatus has both convex and concave aspects. The aim of this study was to compare levator ani hiatus volume measurements obtained with conventional three-dimensional (3D) ultrasound and with a virtual reality measurement technique and to establish their reliability and agreement. 100 symptomatic patients visiting a tertiary pelvic floor clinic with a normal intact levator ani muscle diagnosed on translabial ultrasound were selected. Datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm at the level of minimal hiatal dimensions during contraction. The levator area (in cm(2)) was measured and multiplied by 1.5 to get the levator ani hiatus volume in conventional 3D ultrasound (in cm(3)). Levator ani hiatus volume measurements were then measured semi-automatically in virtual reality (cm(3) ) using a segmentation algorithm. An intra- and interobserver analysis of reliability and agreement was performed in 20 randomly chosen patients. The mean difference between levator ani hiatus volume measurements performed using conventional 3D ultrasound and virtual reality was 0.10 (95% CI, - 0.15 to 0.35) cm(3). The intraclass correlation coefficient (ICC) comparing conventional 3D ultrasound with virtual reality measurements was > 0.96. Intra- and interobserver ICCs for conventional 3D ultrasound measurements were > 0.94 and for virtual reality measurements were > 0.97, indicating good reliability for both. Levator ani hiatus volume measurements performed using virtual reality were reliable and the results were similar to those obtained with conventional 3D ultrasonography. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  14. The Effect of Commonly Performed Exercises on the Levator Hiatus Area and the Length and Strength of Pelvic Floor Muscles in Postpartum Women.

    PubMed

    Siff, Lauren N; Hill, Audra J; Walters, Samantha J; Walters, Ginny; Walters, Mark D

    2018-05-02

    The aim oft his study was to compare the effects of 10 common exercises to traditional pelvic floor muscle (PFM) contractions (Kegel) on levator hiatus (LH) area and PFM length and strength. This is a cross-sectional study of 15 healthy postpartum women. Ten exercises were studied. These were common variations of leg, core, and back exercises used in yoga, Pilates, strength training, and physical therapy. Each participant performed all 10 exercises at a single visit in 2 examination settings: transperineal ultrasound and perineometry. Ultrasound measured the LH area and PFM length, and perineometry measured the muscle strength (peak squeeze pressure). Kegel generates an increase in squeeze pressure (24.3 cm H2O), shortens the muscles (-0.46 cm) and narrows the LH (-0.13 cm). The bird-dog and plank exercises were not different from Kegel in any measurement. While the leg-lift ultrasound dimensions are similar to Kegel, leg lifts generated peak squeeze pressures stronger than any other exercise (including Kegel). Whereas ultrasound dimensions were similar to Kegel, tucked and untucked squats and thigh adductions generated weaker contractions than Kegel. While crunch generated a squeeze pressure similar to Kegel, the ultrasound dimensions showed a significantly wider LH and longer muscle than Kegel. Bridge, clam, and plié exercises affected the PFMs differently than Kegel in all measures. Bird-dog, plank, and leg-lift exercises should be evaluated as alternative exercises to Kegel as they affect PFM strength and length and LH area similarly to Kegel, and leg lifts generate a stronger contraction than Kegel.

  15. A subject-specific anisotropic visco-hyperelastic finite element model of the female pelvic floor stress and strain during the second stage of labor

    PubMed Central

    Jing, Dejun; Ashton-Miller, James A.; DeLancey, John O.L.

    2012-01-01

    Objectives To develop an improved model representation of the biomechanics of the levator muscles during the second stage of labor and to use a sensitivity analysis to explore the pathomechanics of levator muscle injury. Methods A subject-specific finite element model of human pelvic floor and fetal head was developed based on in vivo MRI data of a fetal head and maternal pelvis. An anisotropic visco-hyperelastic constitutive model employed material parameters estimated from biaxial tests on pelvic floor tissues. Boundary conditions reflected both anatomic constraints and the curve of Carus. A short second stage of labor, scaled to 10 minutes, was then simulated using a single expulsive push made in the absence of levator co-contraction. Results Large levator stresses occured near the levator hiatus reaching 9 MPa at the pubovisceral muscle enthesis. The dominant principal stresses were located at, and aligned with, the edge of the hiatus. Muscle stretch bordering the levator hiatus was inhomogeneous: The average levator was 3.55 with a high of 4.64 at the pubovisceral muscle enthesis. Decreasing perineal body stiffness by 40%, 50%, and 60% led to reductions in the maximum principal stretch ratio at the pubovisceral muscle enthesis of 8%, 13%, and 18%, respectively. Conclusions The pubovisceral muscle enthesis and the muscle near the perineal body are the regions of greatest strain thereby placing them at highest risk for stretch-related injury. Decreasing perineal body tissue stiffness significantly reduced tissue stress and strain, and therefore injury risk, in those regions. PMID:22209507

  16. Measurement the thickness of the transverse abdominal muscle in different tasks.

    PubMed

    Pang, Ling; Yin, Liquan; Tajiri, Kimiko; Huo, Ming; Maruyama, Hitoshi

    2017-02-01

    [Purpose] This study examined the measurement of the thickness of the transverse abdominal muscle in different tasks. [Subjects and Methods] The subjects were eleven healthy adult females. Thicknesses of transverse abdominal muscle were measured in seven tasks in the supine position. The tasks were: 1) Resting state, 2) Maximal contraction of transverse abdominal muscle, 3) Maximal contraction of levator ani muscle, 4) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle, 5) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with front side resistance added to both knee, 6) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with diagonal resistance added to both knees, and 7) Maximal simultaneous contraction of both transverse abdominal muscle and levator ani muscle with lateral resistance added to both knees. [Results] The thicknesses of transverse abdominal muscle during maximal simultaneous contraction and maximal simultaneous contraction with resistance were greater than during the resting state. [Conclusion] The muscle output during simultaneous contraction and resistance movement were larger than that of each individual muscle.

  17. Agreement and reliability of pelvic floor measurements during rest and on maximum Valsalva maneuver using three-dimensional translabial ultrasound and virtual reality imaging.

    PubMed

    Speksnijder, L; Oom, D M J; Koning, A H J; Biesmeijer, C S; Steegers, E A P; Steensma, A B

    2016-08-01

    Imaging of the levator ani hiatus provides valuable information for the diagnosis and follow-up of patients with pelvic organ prolapse (POP). This study compared measurements of levator ani hiatal volume during rest and on maximum Valsalva, obtained using conventional three-dimensional (3D) translabial ultrasound and virtual reality imaging. Our objectives were to establish their agreement and reliability, and their relationship with prolapse symptoms and POP quantification (POP-Q) stage. One hundred women with an intact levator ani were selected from our tertiary clinic database. Information on clinical symptoms were obtained using standardized questionnaires. Ultrasound datasets were analyzed using a rendered volume with a slice thickness of 1.5 cm, at the level of minimal hiatal dimensions, during rest and on maximum Valsalva. The levator area (in cm(2) ) was measured and multiplied by 1.5 to obtain the levator ani hiatal volume (in cm(3) ) on conventional 3D ultrasound. Levator ani hiatal volume (in cm(3) ) was measured semi-automatically by virtual reality imaging using a segmentation algorithm. Twenty patients were chosen randomly to analyze intra- and interobserver agreement. The mean difference between levator hiatal volume measurements on 3D ultrasound and by virtual reality was 1.52 cm(3) (95% CI, 1.00-2.04 cm(3) ) at rest and 1.16 cm(3) (95% CI, 0.56-1.76 cm(3) ) during maximum Valsalva (P < 0.001). Both intra- and interobserver intraclass correlation coefficients were ≥ 0.96 for conventional 3D ultrasound and > 0.99 for virtual reality. Patients with prolapse symptoms or POP-Q Stage ≥ 2 had significantly larger hiatal measurements than those without symptoms or POP-Q Stage < 2. Levator ani hiatal volume at rest and on maximum Valsalva is significantly smaller when using virtual reality compared with conventional 3D ultrasound; however, this difference does not seem clinically important. Copyright © 2015 ISUOG. Published by

  18. Anatomy of the pubovisceral muscle origin: Macroscopic and microscopic findings within the injury zone.

    PubMed

    Kim, Jinyong; Betschart, Cornelia; Ramanah, Rajeev; Ashton-Miller, James A; DeLancey, John O L

    2015-11-01

    The levator ani muscle (LA) injury associated with vaginal birth occurs in a characteristic site of injury on the inner surface of the pubic bone to the pubovisceral portion of the levator ani muscle's origin. This study investigated the gross and microscopic anatomy of the pubic origin of the LA in this region. Pubic origin of the levator ani muscle was examined in situ then harvested from nine female cadavers (35-98 years). A combination of targeted feature sampling and sequential sampling was used where each specimen was cut sequentially in approximately 5 mm thick slices apart in the area of known LA injury. Histological sections were stained with Masson's trichrome. The pubovisceral origin is transparent and thin as it attaches tangentially to the pubic periosteum, with its morphology changing from medial to lateral regions. Medially, fibers of the thick muscle belly coalesce toward multiple narrow points of bony attachment for individual fascicles. In the central portion there is an aponeurosis and the distance between muscle and periosteum is wider (∼3 mm) than in the medial region. Laterally, the LA fibers attach to the levator arch where the transition from pubovisceral muscle to the iliococcygeal muscle occurs. The morphology of the levator ani origin varies from the medial to lateral margin. The medial origin is a rather direct attachment of the muscle, while lateral origin is made through the levator arch. © 2014 Wiley Periodicals, Inc.

  19. Linear measurements in 2-dimensional pelvic floor imaging: the impact of slice tilt angles on measurement reproducibility.

    PubMed

    Hoyte, L; Ratiu, P

    2001-09-01

    Magnetic resonance imaging techniques have improved the study of female pelvic dysfunction. However, disagreements between magnetic resonance measurements and their derived 3-dimensional reconstructions were noted. We tested the hypothesis that these discrepancies stemmed from variations in magnetic resonance acquisition angle. Images from the pelvis of the Visible Human Female (a thinly sliced cadaveric image data set) were obtained. Slices in the axial plane were rotated around pivot points in the pelvis to yield a set of similar-appearing para-axial images. A parameter that described the maximum anterior-posterior dimension of the levator hiatus was defined. This levator hiatus parameter was measured on all of the rotated images and compared with an expected value that was calculated from trigonometry. The levator hiatus was also measured on a group of similar-appearing slices rotated slightly around a defined point. In 1 group of slices, expected levator hiatus variation was 1.5 to 6.1%, whereas measured variation was 4% to 15%. Among the similar-appearing rotated slices, 4.8% to 16.0% variations were seen in the levator hiatus. Identical measurements made on radiologic images can vary widely. Slice acquisition must be standardized to avoid errors in data comparison.

  20. Three-Dimensional Magnetic Resonance Imaging of Velopharyngeal Structures

    ERIC Educational Resources Information Center

    Bae, Youkyung; Kuehn, David P.; Sutton, Bradley P.; Conway, Charles A.; Perry, Jamie L.

    2011-01-01

    Purpose: To report the feasibility of using a 3-dimensional (3D) magnetic resonance imaging (MRI) protocol for examining velopharyngeal structures. Using collected 3D MRI data, the authors investigated the effect of sex on the midsagittal velopharyngeal structures and the levator veli palatini (levator) muscle configurations. Method: Ten Caucasian…

  1. Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

    PubMed

    Yoshida, Mikako; Murayama, Ryoko; Haruna, Megumi; Matsuzaki, Masayo; Yoshimura, Kenichi; Murashima, Sachiyo; Kozuma, Shiro

    2013-04-01

    To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p < 0.01), though shortening of the antero-posterior diameter of the levator hiatus was not significantly different between continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p < 0.001). The antero-posterior diameter of the levator hiatus during contraction had shortened only in continent women by 6 months postpartum (p = 0.02). The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.

  2. Ultrasound imaging of the pelvic floor: changes in anatomy during and after first pregnancy.

    PubMed

    van Veelen, G A; Schweitzer, K J; van der Vaart, C H

    2014-10-01

    To describe changes in the absolute values of levator hiatal dimensions and in the contractility and distensibility of the levator hiatus during pelvic floor contraction and Valsalva maneuver, using three/four-dimensional (3D/4D) transperineal ultrasound in women during and after their first pregnancy. Two-hundred and eighty nulliparous pregnant women underwent ultrasound examination at 12 and 36 weeks' gestation and 6 months postpartum. Hiatal dimensions were measured at rest, on pelvic floor contraction and on Valsalva maneuver. The contractility and distensibility were determined by the difference between hiatal dimensions at rest and those on contraction or Valsalva, respectively. After exclusions, there were 231 datasets from women at rest, 199 for pelvic floor contraction and 230 for Valsalva maneuver. Data at 36 weeks' gestation and 6 months postpartum were compared with data at 12 weeks' gestation. At 36 weeks' gestation, the absolute values of hiatal dimensions and the contractility and distensibility of the levator hiatus were significantly increased compared with those at 12 weeks' gestation. Women who delivered vaginally showed a persistent significant increase in hiatal dimensions on Valsalva, whereas women who delivered by prelabor or first-stage Cesarean section showed no significant changes in hiatal dimensions on Valsalva. After both vaginal and Cesarean section delivery, there was a persistent increase in the distensibility of the hiatus during Valsalva compared with in early pregnancy. During first pregnancy, the absolute values of levator hiatal dimensions and the contractility and distensibility of the levator hiatus increase. Regardless of delivery mode, increased distensibility of the levator hiatus during Valsalva persists after childbirth. This increased pelvic floor distensibility may play a role in the development of pelvic floor dysfunction in later life. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  3. Does the prevalence of levator ani muscle avulsion differ when assessed using tomographic ultrasound imaging at rest vs on maximum pelvic floor muscle contraction?

    PubMed

    van Delft, K; Thakar, R; Sultan, A H; Kluivers, K B

    2015-07-01

    It has been suggested that transperineal ultrasound images obtained during maximum pelvic floor muscle contraction improve the diagnosis of levator ani muscle (LAM) avulsion by comparison with those obtained at rest. The objective of this study was to establish, using transperineal tomographic ultrasound imaging (TUI), the correlation between LAM avulsion diagnosed at rest and that on contraction. Primiparous women were examined 3 months postpartum by Pelvic Organ Prolapse Quantification (POP-Q) assessment and for LAM avulsion clinically by digital palpation and by transperineal TUI performed at rest and on pelvic floor muscle contraction. LAM avulsion was diagnosed on TUI when the three central slices were abnormal. A comparison was made between LAM avulsion diagnosed at rest and on maximum contraction. Two independent blinded investigators performed the analyses and a third investigator resolved discrepancies. One hundred and ninety primiparae were analyzed providing 380 results for comparison, as right and left LAM were analyzed independently. LAM avulsion was found in 36 (9.5%) images obtained at rest and in 35 (9.2%) on contraction, revealing moderate correlation between the two (ICC, 0.58 (95% CI, 0.51-0.64)). Twenty-two cases of LAM avulsion were identified both at rest and on contraction. One woman had LAM avulsion on palpation, which was seen on TUI as LAM avulsion on contraction, but not at rest. More cases of anterior and posterior compartment prolapse were found in women with LAM avulsion diagnosed on contraction only compared to LAM avulsion observed at rest only (POP-Q assessment point Ba, -1.8 vs -2.5 (P = 0.075) and point Bp, -2.5 vs -2.8 (P = 0.072)). Findings on transperineal TUI performed in women at rest and on contraction correlate reasonably well. However, given the trend towards an association with signs of pelvic floor dysfunction, diagnosis of LAM avulsion on contraction seems to be more reliable. Consistency in technique and

  4. Eyelid Opening with Trigeminal Proprioceptive Activation Regulates a Brainstem Arousal Mechanism

    PubMed Central

    Matsuo, Kiyoshi; Ban, Ryokuya; Hama, Yuki; Yuzuriha, Shunsuke

    2015-01-01

    Eyelid opening stretches mechanoreceptors in the supratarsal Müller muscle to activate the proprioceptive fiber supplied by the trigeminal mesencephalic nucleus. This proprioception induces reflex contractions of the slow-twitch fibers in the levator palpebrae superioris and frontalis muscles to sustain eyelid and eyebrow positions against gravity. The cell bodies of the trigeminal proprioceptive neurons in the mesencephalon potentially make gap-junctional connections with the locus coeruleus neurons. The locus coeruleus is implicated in arousal and autonomic function. Due to the relationship between arousal, ventromedial prefrontal cortex, and skin conductance, we assessed whether upgaze with trigeminal proprioceptive evocation activates sympathetically innervated sweat glands and the ventromedial prefrontal cortex. Specifically, we examined whether 60° upgaze induces palmar sweating and hemodynamic changes in the prefrontal cortex in 16 subjects. Sweating was monitored using a thumb-mounted perspiration meter, and prefrontal cortex activity was measured with 45-channel, functional near-infrared spectroscopy (fNIRS) and 2-channel NIRS at Fp1 and Fp2. In 16 subjects, palmar sweating was induced by upgaze and decreased in response to downgaze. Upgaze activated the ventromedial prefrontal cortex with an accumulation of integrated concentration changes in deoxyhemoglobin, oxyhemoglobin, and total hemoglobin levels in 12 subjects. Upgaze phasically and degree-dependently increased deoxyhemoglobin level at Fp1 and Fp2, whereas downgaze phasically decreased it in 16 subjects. Unilateral anesthetization of mechanoreceptors in the supratarsal Müller muscle used to significantly reduce trigeminal proprioceptive evocation ipsilaterally impaired the increased deoxyhemoglobin level by 60° upgaze at Fp1 or Fp2 in 6 subjects. We concluded that upgaze with strong trigeminal proprioceptive evocation was sufficient to phasically activate sympathetically innervated sweat glands

  5. Eyelid Opening with Trigeminal Proprioceptive Activation Regulates a Brainstem Arousal Mechanism.

    PubMed

    Matsuo, Kiyoshi; Ban, Ryokuya; Hama, Yuki; Yuzuriha, Shunsuke

    2015-01-01

    Eyelid opening stretches mechanoreceptors in the supratarsal Müller muscle to activate the proprioceptive fiber supplied by the trigeminal mesencephalic nucleus. This proprioception induces reflex contractions of the slow-twitch fibers in the levator palpebrae superioris and frontalis muscles to sustain eyelid and eyebrow positions against gravity. The cell bodies of the trigeminal proprioceptive neurons in the mesencephalon potentially make gap-junctional connections with the locus coeruleus neurons. The locus coeruleus is implicated in arousal and autonomic function. Due to the relationship between arousal, ventromedial prefrontal cortex, and skin conductance, we assessed whether upgaze with trigeminal proprioceptive evocation activates sympathetically innervated sweat glands and the ventromedial prefrontal cortex. Specifically, we examined whether 60° upgaze induces palmar sweating and hemodynamic changes in the prefrontal cortex in 16 subjects. Sweating was monitored using a thumb-mounted perspiration meter, and prefrontal cortex activity was measured with 45-channel, functional near-infrared spectroscopy (fNIRS) and 2-channel NIRS at Fp1 and Fp2. In 16 subjects, palmar sweating was induced by upgaze and decreased in response to downgaze. Upgaze activated the ventromedial prefrontal cortex with an accumulation of integrated concentration changes in deoxyhemoglobin, oxyhemoglobin, and total hemoglobin levels in 12 subjects. Upgaze phasically and degree-dependently increased deoxyhemoglobin level at Fp1 and Fp2, whereas downgaze phasically decreased it in 16 subjects. Unilateral anesthetization of mechanoreceptors in the supratarsal Müller muscle used to significantly reduce trigeminal proprioceptive evocation ipsilaterally impaired the increased deoxyhemoglobin level by 60° upgaze at Fp1 or Fp2 in 6 subjects. We concluded that upgaze with strong trigeminal proprioceptive evocation was sufficient to phasically activate sympathetically innervated sweat glands

  6. Stress-relaxation and fatigue behaviour of synthetic brow-suspension materials.

    PubMed

    Kwon, Kyung-Ah; Shipley, Rebecca J; Edirisinghe, Mohan; Rayment, Andrew W; Best, Serena M; Cameron, Ruth E; Salam, Tahrina; Rose, Geoffrey E; Ezra, Daniel G

    2015-02-01

    Ptosis describes a low position of the upper eyelid. When this condition is due to poor function of the levator palpebrae superioris muscle, responsible for raising the lid, "brow-suspension" ptosis correction is usually performed, which involves internally attaching the malpositioned eyelid to the forehead musculature using brow-suspension materials. In service, such materials are exposed to both rapid tensile loading and unloading sequences during blinking, and a more sustained tensile strain during extended periods of closure. In this study, various mechanical tests were conducted to characterise and compare some of commonly-used synthetic brow-suspension materials (Prolene(®), Supramid Extra(®) II, Silicone rods (Visitec(®) Seiff frontalis suspension set) and Mersilene(®) mesh) for their time-dependent response. At a given constant tensile strain or load, all of the brow-suspension materials exhibited stress-relaxation or creep, with Prolene(®) having a statistically different relaxation or creep ratio as compared with those of others. Uniaxial tensile cyclic tests through preconditioning and fatigue tests demonstrated drastically different time-dependent response amongst the various materials. Although the tests generated hysteresis force-strain loops for all materials, the mechanical properties such as the number of cycles required to reach the steady-state, the reduction in the peak force, and the cyclic energy dissipation varied considerably. To reach the steady-state, Prolene(®) and the silicone rod required the greatest and the least number of cycles, respectively. Furthermore, the fatigue tests at physiologically relevant conditions (15% strain controlled at 6.5 Hz) demonstrated that the reduction in the peak force during 100,000 cycles ranged from 15% to 58%, with Prolene(®) and the silicone rod exhibiting the greatest and the least value, respectively. Many factors need to be considered to select the most suitable brow-suspension material for

  7. Reliability of pelvic floor measurements on three- and four-dimensional ultrasound during and after first pregnancy: implications for training.

    PubMed

    van Veelen, G A; Schweitzer, K J; van der Vaart, C H

    2013-11-01

    To evaluate the reliability of measurements of the levator hiatus and levator-urethra gap (LUG) using three/four-dimensional (3D/4D) transperineal ultrasound in women during their first pregnancy and 6 months postpartum, and to assess the learning process for these measurements. An inexperienced observer was taught to perform measurements of the levator hiatus and LUG by an experienced observer. After training, 3D/4D ultrasound volume datasets of 40 women in the first trimester were analyzed by these two observers. Another training session then took place and both observers repeated the analyses of the same volume datasets. Finally, analyses of 40 volume datasets of the women 6 months postpartum were performed by both observers. Intra- and interobserver reliability were determined by intraclass correlation coefficients (ICC) with 95% CIs. For levator hiatal measurements, in the women during their first pregnancy the interobserver reliability was substantial to almost perfect after both the first and second training session (ICC, 0.62-0.83 and 0.71-0.89, respectively, for anteroposterior diameter, transverse diameter and area at rest, on contraction and on Valsalva) and the intraobserver reliability was substantial to almost perfect for both observers. For these measurements performed once the women had delivered, interobserver reliability was moderate to almost perfect. For LUG measurements performed during pregnancy, interobserver reliability was slight to moderate after the first training session (ICC, 0.14-0.54), but improved after the second training session (ICC, 0.38-0.71), and intraobserver reliability was moderate to substantial for the experienced observer and slight to moderate for the inexperienced observer. For these measurements performed when the women had delivered, interobserver reliability was fair to moderate. The levator hiatus and LUG can be measured reliably using 3D/4D ultrasound in primigravid and primiparous women. The technique to measure

  8. A Ringed Fascia Lata Graft Without Peritendinous Areolar Tissue Encircling the Levator Veli Palatini and Superior Pharyngeal Constrictor Muscles Gradually Shrinks to Reduce Velopharyngeal Incompetence, Functioning as an Intravelar Palatal Lift

    PubMed Central

    Fujita, Kenya; Matsuo, Kiyoshi; Yuzuriha, Shunsuke

    2013-01-01

    Introduction: We have previously reported that fascia lata grafts with peritendinous areolar tissue used to treat severe congenital blepharoptosis gradually shrink within 6 weeks postoperatively and maintain long-term shrinkage of 15.5% on average. Accordingly, it seemed possible that a fascia lata graft without peritendinous areolar tissue would shrink more than the one with peritendinous areolar tissue in a clinical setting. We evaluated this possibility in a patient with Klippel-Feil syndrome having postoperative deep atonic nasopharynx. Methods: In combination with intravelar veloplasty and palatal lengthening with modified bilateral buccinator sandwich pushback, a ringed fascia lata without peritendinous areolar tissue encircling the levator veli palatini and superior constrictor muscles was grafted to cure severe velopharyngeal incompetence. Results: Obstructive sleep apnea did not occur following surgery. Pharyngoscopy, videofluoroscopy, and nasometry showed no amelioration of velopharyngeal incompetence at 1 month postoperatively, but marked velopharyngeal incompetence reduction was evident at 4 months and 2 years after surgery. Conclusions: The extended recovery period suggests that the anticipated postoperative shrinkage of the ringed fascia lata without peritendinous areolar tissue played a more prominent role than intravelar veloplasty and palatal lengthening, which posteroinferiorly elongated the atonic soft palate. Although the pharyngeal flap procedure is the most popular technique for treatment of velopharyngeal incompetence, it is sometimes accompanied by respiratory complications. Thus, the gradual postoperative shrinkage of a ringed fascia lata graft encircling the velopharyngeal muscles functions as an intravelar palatal lift and may be an additional surgical method with less respiratory complications to narrow atonic nasopharyngeal port. PMID:23814637

  9. A ringed fascia lata graft without peritendinous areolar tissue encircling the levator veli palatini and superior pharyngeal constrictor muscles gradually shrinks to reduce velopharyngeal incompetence, functioning as an intravelar palatal lift.

    PubMed

    Fujita, Kenya; Matsuo, Kiyoshi; Yuzuriha, Shunsuke

    2013-01-01

    We have previously reported that fascia lata grafts with peritendinous areolar tissue used to treat severe congenital blepharoptosis gradually shrink within 6 weeks postoperatively and maintain long-term shrinkage of 15.5% on average. Accordingly, it seemed possible that a fascia lata graft without peritendinous areolar tissue would shrink more than the one with peritendinous areolar tissue in a clinical setting. We evaluated this possibility in a patient with Klippel-Feil syndrome having postoperative deep atonic nasopharynx. In combination with intravelar veloplasty and palatal lengthening with modified bilateral buccinator sandwich pushback, a ringed fascia lata without peritendinous areolar tissue encircling the levator veli palatini and superior constrictor muscles was grafted to cure severe velopharyngeal incompetence. Obstructive sleep apnea did not occur following surgery. Pharyngoscopy, videofluoroscopy, and nasometry showed no amelioration of velopharyngeal incompetence at 1 month postoperatively, but marked velopharyngeal incompetence reduction was evident at 4 months and 2 years after surgery. The extended recovery period suggests that the anticipated postoperative shrinkage of the ringed fascia lata without peritendinous areolar tissue played a more prominent role than intravelar veloplasty and palatal lengthening, which posteroinferiorly elongated the atonic soft palate. Although the pharyngeal flap procedure is the most popular technique for treatment of velopharyngeal incompetence, it is sometimes accompanied by respiratory complications. Thus, the gradual postoperative shrinkage of a ringed fascia lata graft encircling the velopharyngeal muscles functions as an intravelar palatal lift and may be an additional surgical method with less respiratory complications to narrow atonic nasopharyngeal port.

  10. A Multi-Compartment 3-D Finite Element Model of Rectocele and Its Interaction with Cystocele

    PubMed Central

    Luo, Jiajia; Chen, Luyun; Fenner, Dee E.; Ashton-Miller, James A.; DeLancey, John O. L.

    2015-01-01

    We developed a subject-specific 3-D finite element model to understand the mechanics underlying formation of female pelvic organ prolapse, specifically a rectocele and its interaction with a cystocele. The model was created from MRI 3-D geometry of a healthy 45 year-old multiparous woman. It included anterior and posterior vaginal walls, levator ani muscle, cardinal and uterosacral ligaments, anterior and posterior arcus tendineus fascia pelvis, arcus tendineus levator ani, perineal body, perineal membrane and anal sphincter. Material properties were mostly from the literature. Tissue impairment was modeled as decreased tissue stiffness based on previous clinical studies. Model equations were solved using Abaqus v 6.11. The sensitivity of anterior and posterior vaginal wall geometry was calculated for different combinations tissue impairments under increasing intraabdominal pressure. Prolapse size was reported as POP-Q point at point Bp for rectocele and point Ba for cystocele. Results show that a rectocele resulted from impairments of the levator ani and posterior compartment support. For 20% levator and 85% posterior support impairments, simulated rectocele size (at POP-Q point: Bp) increased 0.29 mm/cm H2O without apical impairment and 0.36 mm/cm H2O with 60% apical impairment, as intraabdominal pressures increased from 0 to 150 cm H2O. Apical support impairment could result in the development of either a cystocele or rectocele. Simulated repair of posterior compartment support decreased rectocele but increased a preexisting cystocele. We conclude that development of rectocele and cystocele depend on the presence of anterior, posterior, levator and/or or apical support impairments, as well as the interaction of the prolapse with the opposing compartment. PMID:25757664

  11. Postpartum pelvic floor muscle training and urinary incontinence: a randomized controlled trial.

    PubMed

    Hilde, Gunvor; Stær-Jensen, Jette; Siafarikas, Franziska; Ellström Engh, Marie; Bø, Kari

    2013-12-01

    To evaluate whether postpartum pelvic floor muscle training decrease prevalence of any urinary incontinence (UI) in primiparous women with and without UI at inclusion (mixed population) and further to perform stratified analyses on women with and without major levator ani muscle defects. A two-armed assessor-blinded randomized controlled trial including primiparous women 6 weeks after vaginal delivery was conducted. Participants were stratified on major levator ani muscle defects, verified by transperineal ultrasonography, and thereafter randomly allocated to training or control. All participants were taught to contract the pelvic floor muscles. The control participants received no further intervention, whereas training participants attended a weekly supervised pelvic floor muscle training class and performed daily home exercise for 16 weeks. Primary outcome was self-reported UI analyzed by relative risk. We included 175 women, 55 with major levator ani muscle defects and 120 without. Prevalence of UI at baseline was 39.1% in the training group (n=87) and 50% among those in the control group (n=88). Fifteen women (8.6%) were lost to follow-up. At 6 months after delivery (postintervention), 34.5% and 38.6% reported UI in the training and control groups, respectively. Relative risk analysis of UI gave a nonsignificant effect size of 0.89 (95% confidence interval [CI] 0.60-1.32). Results were similar for the stratum with and without major levator ani muscle defects, 0.89 (95% CI 0.51-1.56) and 0.90 (95% CI 0.53-1.52), respectively. Postpartum pelvic floor training did not decrease UI prevalence 6 months after delivery in primiparous women. Stratified analysis on women with and without major levator ani muscle defects showed similar nonsignificant results. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01069484. : I.

  12. Modulation of the cytosolic androgen receptor in striated muscle by sex steroids

    NASA Technical Reports Server (NTRS)

    Rance, N. E.; Max, S. E.

    1982-01-01

    The influence of orchiectomy (GDX) and steroid administration on the level of the cytosolic androgen receptor in the rat levator ani muscle and in rat skeletal muscles (tibialis anterior and extensor digitorum longus) was studied. Androgen receptor binding to muscle cytosol was measured using H-3 methyltrienolone (R1881) as ligand, 100 fold molar excess unlabeled R1881 to assess nonspecific binding, and 500 fold molar excess of triamcinolone acetonide to prevent binding to glucocorticoid and progestin receptors. Results demonstrate that modification of the levels of sex steroids can alter the content of androgen receptors of rat striated muscle. Data suggest that: (1) cytosolic androgen receptor levels increase after orchiectomy in both levator ani muscle and skeletal muscle; (2) the acute increase in receptor levels is blocked by an inhibitor of protein synthesis; and (3) administration of estradiol-17 beta to castrated animals increases receptor binding in levator ani muscle but not in skeletal muscle.

  13. Contraction-induced injury to single permeabilized muscle fibers from normal and congenitally-clefted goat palates.

    PubMed

    Rader, Erik P; Cederna, Paul S; Weinzweig, Jeffrey; Panter, Kip E; Yu, Deborah; Buchman, Steven R; Larkin, Lisa M; Faulkner, John A

    2007-03-01

    Levator veli palatini muscles from normal palates of adult humans and goats are predominantly slow oxidative (type 1) fibers. However, 85% of levator veli palatini fibers from cleft palates of adult goats are physiologically fast (type 2). This fiber composition difference between cleft and normal palates may have implications in palatal function. For limb muscles, type 2 muscle fibers are more susceptible to lengthening contraction-induced injury than are type 1 fibers. We tested the hypothesis that, compared with single permeabilized levator veli palatini muscle fibers from normal palates of adult goats, those from cleft palates are more susceptible to lengthening contraction-induced injury. Congenital cleft palates were the result of chemically-induced decreased movement of the fetal head and tongue causing obstruction of palatal closure. Each muscle fiber was maximally activated and lengthened. Fiber type was determined by contractile properties and gel electrophoresis. Susceptibility to injury was assessed by measuring the decrease in maximum force following the lengthening contraction, expressed as a percentage of the initial force. Compared with fibers from normal palates that were all type 1 and had force deficits of 23 +/- 1%, fibers from cleft palates were all type 2 and sustained twofold greater deficits, 40 +/- 1% (p = .001). Levator veli palatini muscles from cleft palates of goats contain predominantly type 2 fibers that are highly susceptible to lengthening contraction-induced injury. This finding may have implications regarding palatal function and the incidence of velopharyngeal incompetence.

  14. Androgen receptors in the pelvic diaphragm muscles of dogs with and without perineal hernia.

    PubMed

    Mann, F A; Nonneman, D J; Pope, E R; Boothe, H W; Welshons, W V; Ganjam, V K

    1995-01-01

    Levator ani and coccygeus muscle estrogen and androgen receptors were measured in 6, healthy, > or = 5-year-old, noncastrated, male Beagles (controls) and in 24 dogs with perineal hernia. Estrogen and androgen receptor analyses were performed on levator ani and coccygeus muscle specimens obtained from control dogs at the time of castration; contralateral levator ani and coccygeus muscle specimens were assayed 2 months after castration. During herniorrhaphy of dogs with perineal hernia, levator ani (non-castrated, n = 12; castrated, n = 7) and/or coccygeus (noncastrated, n = 5; castrated, n = 4) muscle biopsy specimens were obtained for estrogen and androgen receptor analyses. For estrogen and androgen receptor assays, each muscle biopsy specimen was homogenized in Tris-EDTA-glycerol buffer, and centrifuged at 30,000 x g; extracts were used for binding with ligands: [3H]methyltrienolone (3HR1881) for androgen receptors, and [3H]estradiol-17 beta for estrogen receptors. Extracts were incubated overnight at 0 to 4 C. Nonspecific binding was estimated, using 100-fold concentration of cold ligands. Bound and free hormones were separated, using hydroxylapatite batch assay. Receptor numbers for each tissue were calculated as femtomoles (fmol) per milligram of protein. Quantified data were compared between precastration and postcastration controls, using a paired t-test. One-way ANOVA and Bonferroni post-hoc test were used to compare values for precastration controls, postcastration controls, castrated dogs with perineal hernia, and noncastrated dogs with perineal hernia. Significance was set at P < 0.05.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Normative Velopharyngeal Data in Infants: Implications for Treatment of Cleft Palate.

    PubMed

    Schenck, Graham C; Perry, Jamie L; Fang, Xiangming

    2016-09-01

    Identifying normative data related to velopharyngeal muscles and structures may have clinical significance for infants born with cleft palate, especially as they relate to selection of surgical intervention and postsurgical outcomes. Previous studies suggest that patients whose anatomy postsurgically is dissimilar to that of their normative counterparts are at risk for hypernasal speech. However, studies have not documented what constitutes "normal" anatomy for the clinically relevant population-that is, the infant population. The purpose of this study is to examine a magnetic resonance imaging database (n = 29) related to normative velopharyngeal structures and provide a preliminary comparison to 2 selected patients with repaired cleft palate. Twenty-nine healthy infants between 9 and 23 months of age (mean = 15.2 months) with normal craniofacial and velopharyngeal anatomy were recruited to participate in this study. Normative data were compared to 2 infants with repaired cleft palate between 13 and 15 months of age (mean = 14 months). Quantitative craniometric and velopharyngeal measures from the sagittal and oblique coronal image planes were collected. Variables of interest included: levator muscle, velar, and craniometric measures. Females demonstrated significantly larger intravelar segments compared with males. White infants demonstrated significantly larger levator muscles compared to non-white infants. Infants with repaired cleft palate demonstrated increased overall levator muscle length and levator extravelar length compared with infants with normal velopharyngeal anatomy.Data from the present study provide a normative database for future investigators to utilize as a comparative tool when evaluating infants with normal and abnormal velopharyngeal anatomy.

  16. DSB Task Force Report on Air Dominance: Executive Summary

    DTIC Science & Technology

    2017-01-03

    establish "air superiority" in a localized area and for a period of time as needed to provide freedom of action to ach ieve campaign objectives. Air...cost. To achieve "on-demand air superiori ty," the U.S. must pursue a cross-domain strategy to counter proliferating anti-access and area denial...capability and systems for maintaining air dominance beyond the next decade.ŕ The areas to be addressed included: The projected threat environment

  17. 3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study.

    PubMed

    Volk, Gerd Fabian; Pohlmann, Martin; Finkensieper, Mira; Chalmers, Heather J; Guntinas-Lichius, Orlando

    2014-01-01

    While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment.

  18. 3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study

    PubMed Central

    2014-01-01

    Background While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. Methods A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. Results The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. Conclusion 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment. PMID:24782657

  19. Functional disorders of the anus and rectum

    PubMed Central

    Whitehead, W; Wald, A; Diamant, N; Enck, P; Pemberton, J; Rao, S

    1999-01-01

    In this report the functional anorectal disorders, the etiology of which is currently unknown or related to the abnormal functioning of normally innervated and structurally intact muscles, are discussed. These disorders include functional fecal incontinence, functional anorectal pain, including levator ani syndrome and proctalgia fugax, and pelvic floor dyssynergia. The epidemiology of each disorder is defined and discussed, their pathophysiology is summarized and diagnostic approaches and treatment are suggested. Some suggestions for the direction of future research on these disorders are also given.


Keywords: fecal incontinence; pelvic floor dyssynergia; anismus; proctalgia fugax; levator ani syndrome; constipation; Rome II PMID:10457046

  20. [On the origin, course and influx-vessels of the V. basalis and the V. cerebri interna (author's transl)].

    PubMed

    Lang, J; Köth, R; Reiss, G

    1981-01-01

    Origin, course and influx-vessels of the basal vein are investigated on 100 brains. An anterior formation of the basal vein (textbook) was found in 41%, a posterior formation in 34%. The different possibilities of drainage are examined procentually at the different types. Course and number of the different variations of the influx-vessels are taken into account: Vv. thalamostriata inferiores, gyri olfactorii, ventricularis inferior, peduncularis, cerebri interna, thalamostriata superioris, (terminalis), septi pellucidi anterior, septi pellucidi posterior, atrii medialis, atrii lateralis, nuclei caudati.

  1. Marcus Gunn jaw-winking synkinesis: clinical features and management.

    PubMed

    Demirci, Hakan; Frueh, Bartley R; Nelson, Christine C

    2010-07-01

    To evaluate the clinical features including eyelid excursion and management of Marcus Gunn jaw-winking synkinesis (MGJWS). Observational case series. Forty-eight consecutive patients with MGJWS. Clinical features and management of 48 patients with MGJWS were reviewed retrospectively. Upper eyelid excursion was measured and graded. Complications of surgical intervention were evaluated. Resolution of MGJWS and symmetry of upper eyelids in primary position. Excursion of the ptotic eyelid with jaw movement in MGJWS was graded as mild (<2 mm) in 16% of patients, moderate (2-4 mm) in 76% of patients, and severe (> or = 5 mm) in 8% of patients. Thirty patients with moderate or severe MGJWS underwent disabling of the involved levator muscle and bilateral or unilateral frontalis suspension and had more than 6 months of follow-up. After a mean follow-up of 62 months, MGJWS resolved in 29 (97%) patients and improved from 6 mm to 2 mm in 1 (3%) patient. Relative upper eyelid height was within 1 mm in 87% of patients in primary position and within 1 mm in 80% of patients in downgaze. Twenty-six patients had bilateral frontalis suspension with disabling of unilateral levator muscle on the involved side. Relative upper eyelid height was within 1 mm in 88% of patients in the primary position and within 1 mm in 88% of patients in downgaze. Four non-amblyopic patients had unilateral frontalis suspension with levator muscle disabling. Relative upper eyelid height was symmetrical in 75% of the patients in primary position and in 25% of patients in downgaze. Complications included eyelash ptosis in 10% of the patients, loss of eyelid crease in 10%, and entropion in 3%. Most of the patients with MGJWS exhibited moderate eyelid excursion. Disabling of the involved levator muscle and bilateral frontalis suspension and, in selected cases, disabling of the involved levator muscle and unilateral frontalis suspension were effective in the treatment of MGJWS. Eyelash ptosis and loss of eyelid

  2. Comparative anatomy of the cheek muscles within the Centromochlinae subfamily (Ostariophysi, Siluriformes, Auchenipteridae).

    PubMed

    Sarmento-Soares, Luisa Maria; Porto, Marcovan

    2006-02-01

    Glanidium melanopterum Miranda Ribeiro, a typical representative of the subfamily Centromochlinae (Siluriformes: Auchenipteridae), is herein described myologically and compared to other representative species within the group, Glanidium ribeiroi, G. leopardum, Tatia neivai, T. intermedia, T. creutzbergi, Centromochlus heckelii, and C. existimatus. The structure of seven pairs of striated cephalic muscles was compared anatomically: adductor mandibulae, levator arcus palatini, dilatator operculi, adductor arcus palatini, extensor tentaculi, retractor tentaculi, and levator operculi. We observed broad adductor mandibulae muscles in both Glanidium and Tatia, catfishes with depressed heads and smaller eyes. Similarities between muscles were observed: the presence of a large aponeurotic insertion for the levator arcus palatini muscle; an adductor arcus palatini muscle whose origin spread over the orbitosphenoid, pterosphenoid, and parasphenoid; and the extensor tentaculi muscle broadly attached to the autopalatine. There is no retractor tentaculi muscle in either the Glanidium or Tatia species. On the other hand, in Centromochlus, with forms having large eyes and the tallest head, the adductor mandibulae muscles are slim; there is a thin aponeurotic or muscular insertion for the levator arcus palatini muscle; the adductor arcus palatini muscle originates from a single osseous process, forming a keel on the parasphenoid; the extensor tentaculi muscle is loosely attached to the autopalatine, permitting exclusive rotating and sliding movements between this bone and the maxillary. The retractor tentaculi muscle is connected to the maxilla through a single tendon, so that both extensor and retractor tentaculi muscles contribute to a wide array of movements of the maxillary barbels. A discussion on the differences in autopalatine-maxillary movements among the analyzed groups is given. (c) 2005 Wiley-Liss, Inc.

  3. Anorectal and Pelvic Pain

    PubMed Central

    Bharucha, Adil E.; Lee, Tae Hee

    2016-01-01

    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the three most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first two conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacologic, behavioral, and physical therapy. Opioids should not be avoided, and surgery has a limited role, primarily in refractory interstitial cystitis. PMID:27712641

  4. Successful use of botulinum toxin type a in the treatment of refractory postoperative dyspareunia.

    PubMed

    Park, Amy J; Paraiso, Marie Fidela R

    2009-08-01

    Refractory dyspareunia presents a challenging therapeutic dilemma. A woman with defecatory dysfunction and dyspareunia presented with stage 2 prolapse. She underwent laparoscopic and vaginal pelvic floor reconstruction with excision of endometriosis. The patient experienced increased dyspareunia and de novo vaginismus postoperatively that were refractory to trigger point injections, physical therapy, and medical and surgical management. She underwent botulinum toxin type A injections into her levator ani muscles, which allowed her to have sexual intercourse again after 2 years of apareunia with no recurrence of pain for 12 months. Injecting botulinum toxin into the levator ani muscles shows promise for postoperative patients who develop vaginismus and do not respond to conservative therapy.

  5. Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery.

    PubMed

    Volløyhaug, I; Mørkved, S; Salvesen, Ø; Salvesen, K Å

    2015-10-01

    To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP

  6. Residual defects of the external anal sphincter following primary repair: an observational study using transperineal ultrasound.

    PubMed

    Shek, K L; Guzman-Rojas, R; Dietz, H P

    2014-12-01

    Obstetric anal sphincter tears are common and an important factor in the etiology of anal incontinence. The objective of the study was to evaluate the prevalence of residual defects of the external anal sphincter (EAS) after primary repair of obstetric anal sphincter injury using four-dimensional (4D) transperineal ultrasound and to correlate sonographic findings of residual defects and levator avulsion with significant symptoms of anal incontinence, defined as St Mark's fecal incontinence score (SMIS) of ≥ 5. This was a retrospective observational study. One-hundred and forty women were seen after primary repair of obstetric anal sphincter tears in a dedicated perineal clinic at a tertiary hospital in Australia. They all underwent a standardized interview, and physical and 4D transperineal ultrasound examination. Mean follow-up interval was 1.9 months after delivery. Eighty-nine (64%) women had a 3a/3b tear, 28 (20%) a 3c/4(th) degree tear and 23 (16%) an unclassified 3(rd) degree tear. Thirty-five (25%) patients reported symptoms of anal incontinence. Nine had an SMIS of ≥ 5. A residual defect was found in 56 (40%) cases and levator avulsion in 27 (19%). On multivariate logistic regression, residual defects (P = 0.03; odds ratio (OR) = 6.38; 95% CI, 1.23-33.0) and levator avulsion (P = 0.047; OR = 4.38; 95% CI, 1.02-18.77) were found to be independent risk factors for anal incontinence. Residual defects of the EAS were found on transperineal ultrasound in 40% of women after primary repair of obstetric anal sphincter injuries. Although most were asymptomatic, residual anal sphincter defects and levator avulsion were associated with significant symptoms of anal incontinence as quantified using the SMIS. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  7. Muscle complex saving posterior sagittal anorectoplasty.

    PubMed

    Zaiem, Maher; Zaiem, Feras

    2017-05-01

    Posterior sagittal anorectoplasty (PSARP) published by DeVries and Peña in 1982 had become the preferred surgical technique for the management of anorectal malformations (ARM). The original technique is based upon complete exposure of the anorectal region by means of a median sagittal incision that runs from the sacrum to the anal dimple, cutting through all muscle structures behind the rectum by dividing the levator muscle and the muscle complex. Then, the rectum is located in front of the levator and within the limits of the muscle complex. In this review, we described Muscle Complex Saving-Posterior Sagittal Anorectoplasty (MCS-PSARP), which is a less invasive technique that consists of keeping this funnel-shaped muscle complex completely intact and not divided, and pulling the rectum through this funnel, toward fixing the new anus to the skin. This technique aimed both to respect the lower part of the sphincter mechanism consisting of the muscle complex, and to avoid the disturbance of this important structure by dividing and resuturing it. We presented six cases of male patients who were born with anorectal malformation (ARM) and underwent MCS-PSARP. The surgical technique proved to be feasible to achieve the dissection of the rectal pouch and the division of the rectourethral fistula in all patients, by opening only the upper part of the sphincter mechanism, the levator muscle, and keeping the lower part consisting of intact muscle complex. The early results in our series are encouraging; however, long-term functional outcomes of these patients are awaited. The surgical tips were also discussed. This proposed approach in the management of anorectal malformation cases provides an opportunity to maximize preservation of the existing continence mechanisms. It preserves the muscle complex components of the levator muscle intact, allowing a better function of the continence mechanism. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. [Changes in pelvic organ mobility and ligamentous laxity during pregnancy and postpartum. Review of literature and prospects].

    PubMed

    Gachon, B; Desseauve, D; Fradet, L; Decatoire, A; Lacouture, P; Pierre, F; Fritel, X

    2016-06-01

    The role of pregnancy in pelvic floor disorders occurrence remains poorly known. It might exist a link between changes in ligamentous laxity and changes in pelvic organ mobility during this period. Our objective was to conduct a non-systematic review of literature about changes in pelvic organ mobility as well as in ligamentous laxity during pregnancy and postpartum. From the PubMed, Medline, Cochrane Library and Web of Science database we have selected works which pertains clinical assessment of pelvic organ mobility (pelvic organ prolapse quantification), ultrasound assessment of levator hiatus and urethral mobility, ligamentous laxity assessment during pregnancy and postpartum. Clinical assessments performed in these works show an increase of pelvic organ mobility and perineal distension during pregnancy followed by a recovery phase during postpartum. Pelvic floor imaging shows an increase of levator hiatus area and urethral mobility during pregnancy then a recovery phase in postpartum. Different authors also report an increase of ligamentous laxity (upper and lower limbs) during pregnancy followed by a decrease phase in postpartum. Pelvic organ mobility, ligamentous laxity, levator hiatus and urethral mobility change in a similarly way during pregnancy (increase of mobility or distension) and postpartum (recovery). 3. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  9. Anorectal Disorders

    PubMed Central

    Rao, Satish S. C.; Bharucha, Adil E.; Chiarioni, Giuseppe; Felt-Bersma, Richelle; Knowles, Charles; Malcolm, Allison; Wald, Arnold

    2016-01-01

    This report defines criteria and reviews the epidemiology, pathophysiology, and management of the following common anorectal disorders: fecal incontinence (FI), functional anorectal pain, and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals, and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into 3 subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome and unspecified anorectal pain, the pain lasts more than 30 minutes, but in levator ani syndrome there is puborectalis tenderness. Functional defecation disorders are defined by ≥2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with ≥2 features of impaired evacuation, that is, abnormal evacuation pattern on manometry, abnormal balloon expulsion test, or impaired rectal evacuation by imaging. It includes 2 subtypes: dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating levator ani syndrome and defecatory disorders. PMID:27144630

  10. Anorectal and Pelvic Pain.

    PubMed

    Bharucha, Adil E; Lee, Tae Hee

    2016-10-01

    Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  11. What's new in the functional anatomy of pelvic organ prolapse?

    PubMed

    DeLancey, John O L

    2016-10-01

    Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall to a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic sidewall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support. Failure of the lateral connective tissue attachments between the uterus and vagina to the pelvic wall (cardinal, uterosacral, and paravaginal) are strongly related with prolapse (effect sizes ∼2.5) and are also highly correlated with one another (r ∼ 0.85). Small differences exist with prolapse in factors involving the vaginal wall length and width (effect sizes ∼1). The primary difference in ligament properties between women with and without prolapse is found in ligament length. Only minor differences in ligament stiffness are seen. Pelvic organ prolapse occurs because of injury to the levator ani muscles and failure of the lateral connections between the pelvic organs to the pelvic sidewall. Abnormalities of the vaginal wall fascial tissues may play a minor role.

  12. Role of pelvic floor in lower urinary tract function.

    PubMed

    Chermansky, Christopher J; Moalli, Pamela A

    2016-10-01

    The pelvic floor plays an integral part in lower urinary tract storage and evacuation. Normal urine storage necessitates that continence be maintained with normal urethral closure and urethral support. The endopelvic fascia of the anterior vaginal wall, its connections to the arcus tendineous fascia pelvis (ATFP), and the medial portion of the levator ani muscles must remain intact to provide normal urethral support. Thus, normal pelvic floor function is required for urine storage. Normal urine evacuation involves a series of coordinated events, the first of which involves complete relaxation of the external urethral sphincter and levator ani muscles. Acquired dysfunction of these muscles will initially result in sensory urgency and detrusor overactivity; however, with time the acquired voiding dysfunction can result in intermittent urine flow and incomplete bladder emptying, progressing to urinary retention in severe cases. This review will start with a discussion of normal pelvic floor anatomy and function. Next various injuries to the pelvic floor will be reviewed. The dysfunctional pelvic floor will be covered subsequently, with a focus on levator ani spasticity and stress urinary incontinence (SUI). Finally, future research directions of the interaction between the pelvic floor and lower urinary tract function will be discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. What’s new in the functional anatomy of pelvic organ prolapse?

    PubMed Central

    DeLancey, John O. L.

    2017-01-01

    Purpose of Review Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. Recent Findings Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic side-wall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support. Failure of the connective tissue attachments between the uterus and vagina to the pelvic wall (cardinal, uterosacral, paravaginal) are strongly related with prolapse (effect sizes ~2.5) and are also highly correlated with one another (r ~0.85). Small differences exist with prolapse in factors involving the vaginal wall length and width (effect sizes ~1). The primary difference in ligament properties between women with and without prolapse is found in ligament length. Only minor differences in ligament stiffness are seen. Summary Pelvic organ prolapse occurs due to injury to the levator ani muscles and failure of the connections between the pelvic organs to the pelvic sidewall. Abnormalities of the vaginal wall fascial tissues may play a minor role. PMID:27517338

  14. Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant and Nonpregnant Women: A Preliminary Study.

    PubMed

    Haavik, Heidi; Murphy, Bernadette A; Kruger, Jennifer

    2016-06-01

    The aim of this study was to investigate whether a single session of spinal manipulation of pregnant women can alter pelvic floor muscle function as measured using ultrasonographic imaging. In this preliminary, prospective, comparative study, transperineal ultrasonographic imaging was used to assess pelvic floor anatomy and function in 11 primigravid women in their second trimester recruited via notice boards at obstetric caregivers, pregnancy keep-fit classes, and word of mouth and 15 nulliparous women recruited from a convenience sample of female students at the New Zealand College of Chiropractic. Following bladder voiding, 3-/4-dimensional transperineal ultrasonography was performed on all participants in the supine position. Levator hiatal area measurements at rest, on maximal pelvic floor contraction, and during maximum Valsalva maneuver were collected before and after either spinal manipulation or a control intervention. Levator hiatal area at rest increased significantly (P < .05) after spinal manipulation in the pregnant women, with no change postmanipulation in the nonpregnant women at rest or in any of the other measured parameters. Spinal manipulation of pregnant women in their second trimester increased the levator hiatal area at rest and thus appears to relax the pelvic floor muscles. This did not occur in the nonpregnant control participants, suggesting that it may be pregnancy related. Copyright © 2016. Published by Elsevier Inc.

  15. Cognitive and psychophysiological correlates of disgust in obsessive-compulsive disorder.

    PubMed

    Whitton, Alexis E; Henry, Julie D; Grisham, Jessica R

    2015-03-01

    Evidence suggests that obsessive-compulsive disorder (OCD) is characterized by heightened self-reported disgust, however, it is unclear if this extends to physiology. The relationship between obsessive beliefs and disgust also remains poorly understood. Therefore, we examined whether the heightened trait and self-reported disgust observed in individuals with OCD is reflected in heightened physiological disgust responses. We also examined whether obsessive beliefs are associated with disgust responding. A 3 (group) × 6 (stimulus) repeated measures design was used to examine disgust responses in individuals with OCD to six categories of image stimuli: body waste, contamination, injury, sociomoral, neutral, negative non-disgust. Individuals with OCD (n = 25) were compared to individuals with non-OCD anxiety disorders (n = 21) and healthy participants (n = 25) with respect to trait, self-reported, facial electromyographic and electrodermal disgust responses. Individuals with OCD showed greater disgust propensity and self-reported disgust to images of body waste compared to healthy and anxious participants, however, there were no group differences in physiological responses. After controlling for trait disgust, obsessive beliefs positively correlated with increased self-reported disgust to neutral images and increased levator labii activity to negative non-disgusting images. Although individuals with OCD showed elevated disgust propensity and self-reported ratings of body waste stimuli, there was little evidence that OCD is characterized by an abnormal physiological disgust response. The intensity of obsessive beliefs was associated with a tendency to respond with disgust in contexts that are non-disgusting, indicating that obsessive beliefs may be implicated in pathological disgust. Individuals with OCD display greater levels of disgust propensity and self-reported disgust to images of body waste compared to healthy control participants and individuals with non

  16. Effect of cleft palate repair on the susceptibility to contraction-induced injury of single permeabilized muscle fibers from congenitally-clefted goat palates.

    PubMed

    Rader, Erik P; Cederna, Paul S; McClellan, William T; Caterson, Stephanie A; Panter, Kip E; Yu, Deborah; Buchman, Steven R; Larkin, Lisa M; Faulkner, John A; Weinzweig, Jeffrey

    2008-03-01

    Despite cleft palate repair, velopharyngeal competence is not achieved in approximately 15% of patients, often necessitating secondary surgical correction. Velopharyngeal competence postrepair may require the conversion of levator veli palatini muscle fibers from injury-susceptible type 2 fibers to injury-resistant type 1 fibers. As an initial step to determining the validity of this theory, we tested the hypothesis that, in most cases, repair induces the transformation to type 1 fibers, thus diminishing susceptibility to injury. Single permeabilized levator veli palatini muscle fibers were obtained from normal palates and nonrepaired congenitally-clefted palates of young (2 months old) and adult (14 to 15 months old) goats and from repaired palates of adult goats (8 months old). Repair was done at 2 months of age using a modified von Langenbeck technique. Fiber type was determined by contractile properties and susceptibility to injury was assessed by force deficit, the decrease in maximum force following a lengthening contraction protocol expressed as a percentage of initial force. For normal palates and cleft palates of young goats, the majority of the fibers were type 2 with force deficits of approximately 40%. Following repair, 80% of the fibers were type 1 with force deficits of 20% +/- 2%; these deficits were 45% of those for nonrepaired cleft palates of adult goats (p < .0001). The decrease in the percentage of type 2 fibers and susceptibility to injury may be important for the development of a functional levator veli palatini muscle postrepair.

  17. Eyebrow ptosis after blowout fracture indicates impairment of trigeminal proprioceptive evocation that induces reflex contraction of the frontalis muscle.

    PubMed

    Ban, Ryokuya; Matsuo, Kiyoshi; Ban, Midori; Yuzuriha, Shunsuke

    2013-01-01

    The mixed levator and frontalis muscles lack the interior muscle spindles normally required to induce involuntary contraction of their slow-twitch fibers. To involuntarily move the eyelid and eyebrow, voluntary contraction of the levator nonskeletal fast-twitch muscle fibers stretches the mechanoreceptors in Müller's muscle to evoke trigeminal proprioception, which then induces reflex contraction of the levator and frontalis skeletal slow-twitch muscle fibers. The trigeminal proprioceptive nerve has a long intraorbital course from the mechanoreceptors in Müller's muscle to the superior orbital fissure. Since external force to the globe may cause impairment of trigeminal proprioceptive evocation, we confirmed how unilateral blowout fracture due to a hydraulic mechanism affects ipsilateral eyebrow movement as compared with unilateral zygomatic fracture. In 16 unilateral blowout fracture patients, eyebrow heights were measured on noninjured and injured sides in primary and 60° upward gaze and statistically compared. Eyebrow heights were also measured in primary gaze in 24 unilateral zygomatic fracture patients and statistically compared. In the blowout fracture patients, eyebrow heights on the injured side were significantly smaller than on the noninjured side in both gaze. In the zygomatic fracture patients, eyebrow heights on the injured side were significantly larger than on the noninjured side in primary gaze. Since 60° upward gaze did not recover the eyebrow ptosis observed in primary gaze in blowout fracture patients, such ptosis indicated impairment of trigeminal proprioceptive evocation and the presence of a hydraulic mechanism that may require ophthalmic examination.

  18. Does fibromyalgia influence symptom bother from pelvic organ prolapse?

    PubMed

    Adams, Kerrie; Osmundsen, Blake; Gregory, W Thomas

    2014-05-01

    Determine if women with fibromyalgia report increased bother from pelvic organ prolapse compared with women without fibromyalgia. We performed a cross-sectional study of women with symptomatic prolapse on consultation with a private urogynecology practice within a 46-month period. After matching for age, women with a diagnosis of fibromyalgia were compared with a reference group of women without fibromyalgia. Demographic, POPQ examination, medical history, and pelvic floor symptom data (PFDI, PFIQ, and PISQ-12) were collected. Our primary outcome was to compare the mean Pelvic Floor Distress Inventory (PFDI) scores of women with and without fibromyalgia. The prevalence of fibromyalgia in women evaluated for initial urogynecology consultation during the study period was 114 out of 1,113 (7%). Women with fibromyalgia reported significantly higher symptom bother scores related to pelvic organ prolapse, defecatory dysfunction, urinary symptoms, and sexual function: PFDI (p = 0.005), PFIQ (p=0.010), and PISQ (p=0.018). Women with fibromyalgia were found to have a higher BMI (p=0.008) and were more likely to report a history of sexual abuse, OR 3.1 (95 % CI 1.3, 7.9), and have levator myalgia on examination, OR 3.8 (95% CI 1.5, 9.1). In a linear regression analysis, levator myalgia was found to be the significant factor associated with pelvic floor symptom bother. In women with symptomatic prolapse, fibromyalgia is associated with an increased risk of levator myalgia and 50% more symptom bother from pelvic floor disorders.

  19. The OECD program to validate the rat Hershberger bioassay to screen compounds for in vivo and androgen and antiandrogen responses: Phase-2 dose-response studies

    EPA Science Inventory

    DESIGN: The Hershberger bioassay is designed to identify suspected androgens and antiandrogens based on changes in the weights of five androgen-responsive tissues (ventral prostate, paired seminal vesicles and coagulating glands, the levator ani and bulbocavernosus muscles, the g...

  20. Effect of cleft palate repair on the susceptibility to contraction-induced injury of single permeabilized muscle fibers from congenitally-clefted goat palates.

    USDA-ARS?s Scientific Manuscript database

    Despite cleft palate repair, velopharyngeal competence is not achieved in ~ 15% of patients, often necessitating secondary surgical correction. Velopharyngeal competence postrepair may require the conversion of levator veli palatini muscle fibers from injury-susceptible type 2 fibers to injury-resi...

  1. Testosterone enhances C-14 2-deoxyglucose uptake by striated muscle. [sex hormones and muscle

    NASA Technical Reports Server (NTRS)

    Toop, J.; Max, S. R.

    1982-01-01

    The effect of testosterone propionate (TP) on C-14 2-deoxyglucose (C-14 2DG) uptake was studied in the rat levator ani muscle in vivo using the autoradiographic technique. Following a delay of 1 to 3 h after injecting TP, the rate of C-14 2DG uptake in experimental animals began to increase and continued to increase for at least 20 h. The label, which corresponds to C-14 2-deoxyglucose 6-phosphate, as demonstrated by chromatographic analysis of muscle extracts, was uniformly distributed over the entire muscle and was predominantly in muscle fibers, although nonmuscular elements were also labeled. The 1 to 3 h time lag suggests that the TP effect may be genomic, acting via androgen receptors, rather than directly on muscle membranes. Acceleration of glucose uptake may be an important early event in the anabolic response of the rat levator ani muscle to androgens.

  2. Eyebrow Ptosis After Blowout Fracture Indicates Impairment of Trigeminal Proprioceptive Evocation That Induces Reflex Contraction of the Frontalis Muscle

    PubMed Central

    Ban, Ryokuya; Matsuo, Kiyoshi; Ban, Midori; Yuzuriha, Shunsuke

    2013-01-01

    Objective: The mixed levator and frontalis muscles lack the interior muscle spindles normally required to induce involuntary contraction of their slow-twitch fibers. To involuntarily move the eyelid and eyebrow, voluntary contraction of the levator nonskeletal fast-twitch muscle fibers stretches the mechanoreceptors in Müller's muscle to evoke trigeminal proprioception, which then induces reflex contraction of the levator and frontalis skeletal slow-twitch muscle fibers. The trigeminal proprioceptive nerve has a long intraorbital course from the mechanoreceptors in Müller's muscle to the superior orbital fissure. Since external force to the globe may cause impairment of trigeminal proprioceptive evocation, we confirmed how unilateral blowout fracture due to a hydraulic mechanism affects ipsilateral eyebrow movement as compared with unilateral zygomatic fracture. Methods: In 16 unilateral blowout fracture patients, eyebrow heights were measured on noninjured and injured sides in primary and 60° upward gaze and statistically compared. Eyebrow heights were also measured in primary gaze in 24 unilateral zygomatic fracture patients and statistically compared. Results: In the blowout fracture patients, eyebrow heights on the injured side were significantly smaller than on the noninjured side in both gaze. In the zygomatic fracture patients, eyebrow heights on the injured side were significantly larger than on the noninjured side in primary gaze. Conclusion: Since 60° upward gaze did not recover the eyebrow ptosis observed in primary gaze in blowout fracture patients, such ptosis indicated impairment of trigeminal proprioceptive evocation and the presence of a hydraulic mechanism that may require ophthalmic examination. PMID:23814636

  3. Fascial structures and autonomic nerves in the female pelvis: a study using macroscopic slices and their corresponding histology.

    PubMed

    Tamakawa, Mitsuharu; Murakami, Gen; Takashima, Ken; Kato, Tomoyasu; Hareyama, Masato

    2003-12-01

    We investigated the topographical anatomy of the pelvic fasciae and autonomic nerves using macroscopic slices of five decalcified female pelves. The lateral aspect of the supravaginal cervix uteri and superior-most vagina issued abundant thick fiber bundles. These visceral fibrous tissues extended dorsolaterally, joined another fibrous tissue from the rectum (the actual lateral ligament of the rectum) and attached to the parietal fibrous tissues at and around the sciatic foramina (i.e. the sacrospinous ligament, thick fasciae of the coccygeus and piriformis and dorsal end of the covering fascia of the levator ani). The inferior or ventral vagina also issued thick fiber bundles communicating with the levator ani fascia. This connection between the vagina and levator fascia, when stretched, seemed to provide a macroscopic morphology called the arcus tendineus fasciae pelvis. The overall morphology of the visceroparietal fascial bridge exhibited a bilateral wing-like shape. The fascial bridge complex was adjacent but dorso-inferior to the internal iliac vascular sheath and located slightly ventral to the pelvic splanchnic nerve. However, the pelvic plexus and its peripheral branches were embedded in the fascial complex. The hypogastric nerve ran along and beneath the uterosacral peritoneal fold, which did not contain thick fibrous tissue. During surgery, in combination with the superficially located vascular sheath, the morphology of the visceroparietal fascial bridge and associated nerves seemed to be artificially changed and developed into the so-called cardinal, uterosacral, uterovesical and/or rectal lateral ligaments. The classical and original concepts of these pelvic fascial structures may need to be altered to adjust to these surgical observations.

  4. Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil.

    PubMed

    Araujo Júnior, Edward; de Freitas, Rogério Caixeta Moraes; Di Bella, Zsuzsanna Ilona Katalin de Jármy; Alexandre, Sandra Maria; Nakamura, Mary Uchiyama; Nardozza, Luciano Marcondes Machado; Moron, Antonio Fernandes

    2013-03-01

    To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm(2), respectively, versus 12.4 cm(2) in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

  5. Pelvic floor muscle biometry and pelvic organ mobility in East Asian and Caucasian nulliparae.

    PubMed

    Cheung, R Y K; Shek, K L; Chan, S S C; Chung, T K H; Dietz, H P

    2015-05-01

    To compare the differences in levator ani muscle biometry and hiatal dimensions between pregnant nulliparous Caucasian and East Asian women. Offline analysis of three/four-dimensional ultrasound volume data obtained from two groups of pregnant nulliparous women, Caucasian and East Asian, was performed. Volume acquisition was performed in the late third trimester using the same method in both groups, in the context of two prospective observational studies with identical entry criteria. Pelvic organ descent and levator hiatal dimensions were assessed using the volumes acquired on Valsalva maneuver, and pubovisceral muscle thickness was measured from the volumes obtained on pelvic floor muscle contraction (PFMC). Datasets of 200 East Asian and 168 Caucasian women were analyzed. Compared with Caucasian women, East Asian women had a significantly lower body mass index. All indices of pelvic organ descent were significantly higher in the Caucasian group than in the East Asian group. The difference, expressed as a percentage, in levator hiatal area on both Valsalva maneuver and PFMC was markedly greater in Caucasian (32% vs. 19%; P < 0.001) than in East Asian (24% vs. 20%; P = 0.01) women. After controlling for potential confounders using multivariate regression analysis, racial origin remained the only significant factor associated with differences in pelvic organ descent and hiatal dimensions. The thickness and area of pubovisceral muscle were significantly higher in the East Asian group. Pregnant women of East Asian racial origin have a thicker pubovisceral muscle, smaller hiatus and less mobility of pelvic organs than do pregnant Caucasian women. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  6. The Effect of Cleft Palate Repair on Contractile Properties of Single Permeabilized Muscle Fibers From Congenitally Cleft Goats Palates

    USDA-ARS?s Scientific Manuscript database

    A cleft palate goat model was used to study the contractile properties of the levator veli palatini (LVP) muscle which is responsible for the movement of the soft palate. In 15-25% of patients that undergo palatoplasty, residual velopharyngeal insufficiency (VPI) remains a problem and often require...

  7. Evolution of the head-trunk interface in tetrapod vertebrates

    PubMed Central

    Sefton, Elizabeth M; Bhullar, Bhart-Anjan S; Mohaddes, Zahra; Hanken, James

    2016-01-01

    Vertebrate neck musculature spans the transition zone between head and trunk. The extent to which the cucullaris muscle is a cranial muscle allied with the gill levators of anamniotes or is instead a trunk muscle is an ongoing debate. Novel computed tomography datasets reveal broad conservation of the cucullaris in gnathostomes, including coelacanth and caecilian, two sarcopterygians previously thought to lack it. In chicken, lateral plate mesoderm (LPM) adjacent to occipital somites is a recently identified embryonic source of cervical musculature. We fate-map this mesoderm in the axolotl (Ambystoma mexicanum), which retains external gills, and demonstrate its contribution to posterior gill-levator muscles and the cucullaris. Accordingly, LPM adjacent to the occipital somites should be regarded as posterior cranial mesoderm. The axial position of the head-trunk border in axolotl is congruent between LPM and somitic mesoderm, unlike in chicken and possibly other amniotes. DOI: http://dx.doi.org/10.7554/eLife.09972.001 PMID:27090084

  8. Ontogeny of the cranial musculature in Corydoras aeneus Callichthyidae, Siluriformes.

    PubMed

    Huysentruyt, F; Brunain, M; Adriaens, D

    2009-11-01

    A complete study of the early ontogeny of the cranial muscles of Corydoras aeneus (Callichthyidae) was undertaken and results were compared with those for the loricariid Ancistrus cf. triradiatus. This comparison reveals a high degree of similarity in the ontogeny of both species' cranial muscles. Both species lack a musculus protractor hyoidei, and the musculus intermandibularis posterior is divided into two different parts that have partly obtained a novel function (serving the lower lip) in A. cf. triradiatus. A similar increase in muscular complexity in this species is found in the dorsal constrictor of the hyoid muscle plate. This constrictor gives rise to the same muscles in both C. aeneus and A. cf. triradiatus, but in A. cf. triradiatus the musculus levator operculi later hypertrophies. In C. aeneus the musculus extensor tentaculi forms a single muscle diverging posteriorly, whereas in A. cf. triradiatus the musculus extensor tentaculi differentiates into two separate bundles. Also, a loricariid neoformation is present called the musculus levator tentaculi.

  9. Velopharyngeal closure and the longus capitis muscle.

    PubMed

    Yamawaki, Y; Nishimura, Y; Suzuki, Y

    1996-09-01

    The dynamic mechanism of velopharyngeal function not only in normal individuals but also in patients with velopharyngeal insufficiency, which is mainly related to cleft palate, has been the subject of considerable interest and controversy. Recently, in order to clarify velopharyngeal movement in the valvular action on phonation we examined dynamic MR images of this area taken in the transverse plane in parallel with the muscle sling of levator veli palatini. In cases in whom the closure pattern in that plane is circular, detailed observation revealed a very interesting result; that is, the longus capitis muscle, one of the group of anterior vertebral muscles, is directly involved in velopharyngeal valving function. It has not previously been reported that the longus capitis muscle acts as one of the velopharyngeal closure muscles, in addition to levator veli palatini. The present study demonstrated that contraction of the muscle contributed to velopharyngeal closure by forward movement of the pharyngeal wall.

  10. Pelvic floor dysfunction--does menopause duration matter?

    PubMed

    Trutnovsky, Gerda; Guzman-Rojas, Rodrigo; Martin, Andrew; Dietz, Hans P

    2013-10-01

    To explore the effect of menopause and hormone replacement therapy on pelvic organ prolapse and pelvic floor muscle function. The records of patients who attended a tertiary urogynaecological center were reviewed retrospectively. A standardised interview included menopausal age, i.e. years since last period or onset of menopausal symptoms, current or previous hormone use. The clinical examination included prolapse assessment (POP-Q) and palpation of the levator ani muscle. 4D transperineal ultrasound, supine and after voiding, was performed in all patients. Volume data sets were analysed for pelvic organ descent and measures of contractility and distensibility of the pelvic floor at a later date, blinded to all clinical data. Of 311 women seen during the inclusion period, 65% were postmenopausal. Current systemic or local hormone use was reported by 7% and 6%, respectively. 163 women (52%) reported prolapse symptoms with a mean bother of 5.7/10. Significant pelvic organ prolapse was found on clinical examination (POP-Q stage≥2) in 77%, and diagnosed on ultrasound in 61%. On multivariate analysis, controlling for calendaric age, parity and levator avulsion, there was no evidence for menopausal age as an independent predictor of any symptom and sign of pelvic organ prolapse and pelvic floor muscle function. Local oestrogen use and past or present hormone replacement therapy had no detectable effect on any pelvic floor parameter. Hormone deficiency following menopause is unlikely to play a major role in pelvic organ support and levator ani function. Hence, both do not appear to be substantially influenced by local or systemic hormone replacement therapy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Electrical stimulation to the trigeminal proprioceptive fibres that innervate the mechanoreceptors in Müller's muscle induces involuntary reflex contraction of the frontalis muscles.

    PubMed

    Matsuo, Kiyoshi; Osada, Yoshiro; Ban, Ryokuya

    2013-02-01

    The levator and frontalis muscles lack interior muscle spindles, despite consisting of slow-twitch fibres that involuntarily sustain eyelid-opening and eyebrow-raising against gravity. To compensate for this anatomical defect, this study hypothetically proposes that initial voluntary contraction of the levator fast-twitch muscle fibres stretches the mechanoreceptors in Müller's muscle and evokes proprioception, which continuously induces reflex contraction of slow-twitch fibres of the levator and frontalis muscles. This study sought to determine whether unilateral transcutaneous electrical stimulation to the trigeminal proprioceptive fibres that innervate the mechanoreceptors in Müller's muscle could induce electromyographic responses in the frontalis muscles, with monitoring responses in the orbicularis oculi muscles. The study population included 27 normal subjects and 23 subjects with aponeurotic blepharoptosis, who displayed persistently raised eyebrows on primary gaze and light eyelid closure. The stimulation induced a short-latency response in the ipsilateral frontalis muscle of all subjects and long-latency responses in the bilateral frontalis muscles of normal subjects. However, it did not induce long-latency responses in the bilateral frontalis muscles of subjects with aponeurotic blepharoptosis. The orbicularis oculi muscles showed R1 and/or R2 responses. The stimulation might reach not only the proprioceptive fibres, but also other sensory fibres related to the blink or corneal reflex. The experimental system can provoke a monosynaptic short-latency response in the ipsilateral frontalis muscle, probably through the mesencephalic trigeminal proprioceptive neuron and the frontalis motor neuron, and polysynaptic long-latency responses in the bilateral frontalis muscles through an unknown pathway. The latter neural circuit appeared to be engaged by the circumstances of aponeurotic blepharoptosis.

  12. Effect of postpartum pelvic floor muscle training on vaginal symptoms and sexual dysfunction-secondary analysis of a randomised trial.

    PubMed

    Kolberg Tennfjord, M; Hilde, G; Staer-Jensen, J; Siafarikas, F; Engh, M Ellström; Bø, K

    2016-03-01

    Evaluate effect of pelvic floor muscle training (PFMT) on vaginal symptoms and sexual matters, dyspareunia and coital incontinence in primiparous women stratified by major or no defects of the levator ani muscle. Randomised controlled trial (RCT). Akershus University Hospital, Norway. About 175 primiparous women with a singleton vaginal delivery. Two-armed assessor blinded parallel group RCT from 6 weeks to 6 months postpartum comparing effect of PFMT versus control. International Consultation on Incontinence Modular Questionnaire-vaginal symptoms questionnaire (ICIQ-VS) and ICIQ sexual matters module (ICIQ-FLUTSsex). Overall, analysis (n = 175) showed no difference between training and control groups in women having vaginal symptoms or symptoms related to sexual dysfunction 6 months postpartum. The majority of women (88%) had intercourse and there was no difference between groups. Unadjusted subgroup analysis of women with a major defect of the levator ani muscle (n = 55) showed that women in the training group had 45% less risk of having the symptom 'vagina feels loose or lax' compared with the control group (relative risk 0.55, 95% confidence interval 0.31, 0.95; P = 0.03). Unadjusted analysis showed that in women with major defect of the levator ani muscle, significantly fewer in the training group had the symptom 'vagina feels loose or lax' compared with the control group. No difference was found between groups for symptoms related to sexual dysfunction. More studies are needed to explore effect of PFMT on vaginal symptoms and sexual dysfunction. Unadjusted analysis shows that PFMT might prevent symptoms of 'vagina feels loose or lax'. © 2015 Royal College of Obstetricians and Gynaecologists.

  13. On the Stiffness of the Mesh and Urethral Mobility: A Finite Element Analysis.

    PubMed

    Brandão, Sofia; Parente, Marco; Da Roza, Thuane Huyer; Silva, Elisabete; Ramos, Isabel Maria; Mascarenhas, Teresa; Natal Jorge, Renato Manuel

    2017-08-01

    Midurethral slings are used to correct urethral hypermobility in female stress urinary incontinence (SUI), defined as the complaint of involuntary urine leakage when the intra-abdominal pressure (IAP) is increased. Structural and thermal features influence their mechanical properties, which may explain postoperative complications, e.g., erosion and urethral obstruction. We studied the effect of the mesh stiffness on urethral mobility at Valsalva maneuver, under impairment of the supporting structures (levator ani and/or ligaments), by using a numerical model. For that purpose, we modeled a sling with "lower" versus "higher" stiffness and evaluated the mobility of the bladder and urethra, that of the urethrovesical junction (the α-angle), and the force exerted at the fixation of the sling. The effect of impaired levator ani or pubourethral ligaments (PUL) alone on the organs displacement and α-angle opening was similar, showing their important role together on urethral stabilization. When the levator ani and all the ligaments were simulated as impaired, the descent of the bladder and urethra went up to 25.02 mm, that of the bladder neck was 14.57 mm, and the α-angle was 129.7 deg, in the range of what was found in women with SUI. Both meshes allowed returning to normal positioning, although at the cost of higher force exerted by the mesh with higher stiffness (3.4 N against 2.3 N), which can relate to tissue erosion. This finite element analysis allowed mimicking the biomechanical response of the pelvic structures in response to changing a material property of the midurethral synthetic mesh.

  14. Preliminary Outcome of Individualized Abdominoperineal Excision for Locally Advanced Low Rectal Cancer.

    PubMed

    Zheng, Yi; Han, Jia-Gang; Wang, Zhen-Jun; Gao, Zhi-Gang; Wei, Guang-Hui; Zhai, Zhi-Wei; Zhao, Bao-Cheng

    2018-06-05

    The introduction of individualized abdominoperineal excision (APE) may minimize operative trauma and reduce the rate of complications. The purpose of this study was to evaluate the safety and efficacy of individualized APE for low rectal cancer. Fifty-six patients who underwent individualized APE from June 2011 to June 2015 were evaluated retrospectively in Beijing Chaoyang Hospital, Capital Medical University. The main outcome measures were circumferential resection margin (CRM) involvement, intraoperative perforation, postoperative complications, and local recurrence. Statistical analysis was performed using SPSS version 16.0. Fifty (89%) patients received preoperative chemoradiotherapy: 51 (91%) patients were treated with the sacrococcyx preserved; 27 (48%) patients with the levator ani muscle partially preserved bilaterally; 20 (36%) patients with the levator ani muscle partially preserved unilaterally and the muscle on the opposite side totally preserved; 7 (13%) patients with intact levator ani muscle and part of the ischioanal fat bilaterally dissected; and 2 (4%) patients with part of the ischioanal fat and intact lavator ani muscle dissected unilaterally and the muscle on the opposite side partially preserved. The most common complications included sexual dysfunction (12%), perineal wound complications (13%), urinary retention (7%), and chronic perineal pain (5%). A positive CRM was demonstrated in 3 (5%) patients, and intraoperative perforations occurred in 2 (4%) patients. On multiple logistic regression analysis, longer operative time (P = 0.032) and more intraoperative blood loss (P = 0.006) were significantly associated with perineal procedure-related complications. The local recurrence was 4% at a median follow-up of 53 months (range: 30-74 months). With preoperative chemoradiotherapy, individualized APE may be a relatively safe and feasible approach for low rectal cancer with acceptable oncological outcomes.

  15. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain.

    PubMed

    Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S; Zebis, Mette K

    2011-07-22

    Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. ISRCTN60264809.

  16. Linear scleroderma associated with ptosis and motility disorders.

    PubMed Central

    Suttorp-Schulten, M S; Koornneef, L

    1990-01-01

    A case is reported in which an 11-year-old girl developed progressive ptosis and a subsequent motility disorder of the right eye. The diagnosis linear scleroderma en coup de sabre was established. Atrophy of the upper levator palpebral and superior rectus muscle could be shown on CT scan. Images PMID:2223709

  17. Comparison of the Pharmacological Effects of a Novel Selective Androgen Receptor Modulator, the 5α-Reductase Inhibitor Finasteride, and the Antiandrogen Hydroxyflutamide in Intact Rats: New Approach for Benign Prostate Hyperplasia

    PubMed Central

    Gao, Wenqing; Kearbey, Jeffrey D.; Nair, Vipin A.; Chung, Kiwon; Parlow, A. F.; Miller, Duane D.; Dalton, James T.

    2007-01-01

    Tissue-selective androgen receptor modulators (SARMs) demonstrate tissue selectivity in both castrated and intact male rats, behaving as partial agonists in androgenic tissues (i.e. prostate and seminal vesicle), but full agonists in anabolic tissues (i.e. levator ani muscle). The partial agonist activity of SARMs (compounds S-1 and S-4) in the prostate of intact rats suggested that SARM could be used for androgen suppression in the treatment of benign prostate hyperplasia (BPH). This study was designed to explore the mechanisms of action of SARM and to characterize the tissue selectivity of S-1 in intact male rats compared with that of hydroxyflutamide (antiandrogen) and finasteride (5α-reductase inhibitor), two major drugs used for androgen suppression treatment of BPH. In intact male rats, S-1 (5, 10, and 25 mg/kg) selectively decreased the prostate weight with similar efficacy to finasteride (5 mg/kg), without affecting the levator ani muscle or increasing the plasma levels of testosterone, LH, and FSH. Hydroxyflutamide (0.5, 1, 5, 10, and 25 mg/kg), however, decreased both the prostate and levator ani muscle weights without any selectivity and increased plasma hormone levels in a dose-dependent manner. Furthermore, S-1 and S-4 showed very weak inhibitory effects toward transiently expressed type I and II human 5α-reductase (Ki, >20 µM) during in vitro assays. Therefore, although S-1 and finasteride showed very similar suppressive effects in the prostate of intact male rats, they decreased prostate size via different mechanisms of action. S-1 simply worked as androgen receptor partial agonist, whereas finasteride inhibited prostatic 5α-reductase. These studies indicate that SARMs may demonstrate clinical utility as single agent or combination therapy for BPH. PMID:15308613

  18. Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

    PubMed Central

    2011-01-01

    Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809 PMID:21777478

  19. An agonist–antagonist cerebellar nuclear system controlling eyelid kinematics during motor learning

    PubMed Central

    Sánchez-Campusano, Raudel; Gruart, Agnès; Fernández-Mas, Rodrigo; Delgado-García, José M.

    2012-01-01

    The presence of two antagonistic groups of deep cerebellar nuclei neurons has been reported as necessary for a proper dynamic control of learned motor responses. Most models of cerebellar function seem to ignore the biomechanical need for a double activation–deactivation system controlling eyelid kinematics, since most of them accept that, for closing the eyelid, only the activation of the orbicularis oculi (OO) muscle (via the red nucleus to the facial motor nucleus) is necessary, without a simultaneous deactivation of levator palpebrae motoneurons (via unknown pathways projecting to the perioculomotor area). We have analyzed the kinetic neural commands of two antagonistic types of cerebellar posterior interpositus neuron (IPn) (types A and B), the electromyographic (EMG) activity of the OO muscle, and eyelid kinematic variables in alert behaving cats during classical eyeblink conditioning, using a delay paradigm. We addressed the hypothesis that the interpositus nucleus can be considered an agonist–antagonist system controlling eyelid kinematics during motor learning. To carry out a comparative study of the kinetic–kinematic relationships, we applied timing and dispersion pattern analyses. We concluded that, in accordance with a dominant role of cerebellar circuits for the facilitation of flexor responses, type A neurons fire during active eyelid downward displacements—i.e., during the active contraction of the OO muscle. In contrast, type B neurons present a high tonic rate when the eyelids are wide open, and stop firing during any active downward displacement of the upper eyelid. From a functional point of view, it could be suggested that type B neurons play a facilitative role for the antagonistic action of the levator palpebrae muscle. From an anatomical point of view, the possibility that cerebellar nuclear type B neurons project to the perioculomotor area—i.e., more or less directly onto levator palpebrae motoneurons—is highly appealing. PMID

  20. Botulinum neurotoxin type A injections for vaginismus secondary to vulvar vestibulitis syndrome.

    PubMed

    Bertolasi, Laura; Frasson, Emma; Cappelletti, Jee Yun; Vicentini, Silvana; Bordignon, Monia; Graziottin, Alessandra

    2009-11-01

    To investigate whether botulinum neurotoxin type A improves vaginismus and study its efficacy with repeated treatments. Outpatients were referred because standard cognitive-behavioral and medical treatment for vaginismus and vulvar vestibular syndrome failed. From this group, we prospectively recruited consecutive women (n=39) whose diagnostic electromyogram (EMG) recordings from the levator ani muscle showed hyperactivity at rest and reduced inhibition during straining. These women were followed for a mean (+/-standard deviation) of 105 (+/-50) weeks. Recruited patients underwent repeated cycles of botulinum neurotoxin type A injected into the levator ani under EMG guidance and EMG monitoring thereafter. At enrollment and 4 weeks after each cycle, women were asked about sexual intercourse; underwent EMG evaluation and examinations to grade vaginal resistance according to Lamont; and completed a visual analog scale (VAS) for pain, the Female Sexual Function Index Scale, a quality-of-life questionnaire (Short-Form 12 Health Survey), and bowel and bladder symptom assessment. At 4 weeks after the first botulinum neurotoxin type A cycle, the primary outcome measures (the possibility of having sexual intercourse, and levator ani EMG hyperactivity) both improved, as did the secondary outcomes, Lamont scores, VAS, Female Sexual Function Index Scales, Short-Form 12 Health Survey, and bowel-bladder symptoms. These benefits persisted through later cycles. When follow-up ended, 63.2% of the patients completely recovered from vaginismus and vulvar vestibular syndrome, 15.4% still needed reinjections (censored), and 15.4% had dropped out. Botulinum neurotoxin type A is an effective treatment option for vaginismus secondary to vulvar vestibular syndrome refractory to standard cognitive-behavioral and medical management. After patients received botulinum neurotoxin type A, their sexual activity improved and reinjections provided sustained benefits. III.

  1. Pelvic and perineal anatomy of the male gorilla: selected observations.

    PubMed

    Oelrich, T M

    1978-08-01

    The anatomy of parts of the pelvic outlet and perineum is described in an adult male gorilla. Two previously undescribed muscles are presented: (1) The puborectalis muscle, completely separated from the levator ani, arises from the region of the symphysis and forms a sling for the rectum while it also substitutes for the perineal membrane. (2) The puboampullaris muscle, a paired smooth muscle, arises from the pubis and inserts into the rectum to elevate the rectum while additionally providing support for the urogenital viscera. The levator ani muscle is recounted to point out its lack of attachment to the pelvic viscera while allowing a hiatus in which the rectum is exposed within the perineum. The sphincter urethrae muscle is presented emphasizing its true sphincteric characteristics, its absence of lateral attachments and its similarity to man. Other muscles of the pelvis and perineum as well as urogenital viscera are described or modified where necessary. The manner in which these structures enter into the support of the pelvic viscera is considered.

  2. Surgical anatomy of the prostate in the era of radical robotic prostatectomy.

    PubMed

    Walz, Jochen; Graefen, Markus; Huland, Hartwig

    2011-05-01

    New insights in the anatomy of the prostate and the surrounding tissue evolve the technique of radical prostatectomy for the treatment of prostate cancer. Regarding the course of the erectile nerves along the prostate, recent studies confirmed the presence of parasympathetic pro-erectile nerve fibers at the anterolateral aspect of the prostate. Another study of intraoperative electrostimulation of those nerves confirmed an increase in intracavernosal pressure by stimulations between the 1 and 3 o'clock position. Therefore, it is very likely that these anterior nerve fibers have an effect on erectile function. Regarding the urethral sphincter in the male, a study showed no attachment of the external sphincter to the levator ani muscle, probably resulting in an absence of a levator ani support to the continence mechanism. The male urinary sphincter seems to be in isolation responsible for urinary continence. The nerve fibers at the anterolateral aspect of the prostate seem to participate in erectile function, which renders the concept of a high anterior release during nerve sparing beneficial. The isolated urinary sphincter mechanism results in the need to conserve as much urethral length as possible during radical prostatectomy to avoid urinary incontinence.

  3. Reference-tissue correction of T2-weighted signal intensity for prostate cancer detection

    NASA Astrophysics Data System (ADS)

    Peng, Yahui; Jiang, Yulei; Oto, Aytekin

    2014-03-01

    The purpose of this study was to investigate whether correction with respect to reference tissue of T2-weighted MRimage signal intensity (SI) improves its effectiveness for classification of regions of interest (ROIs) as prostate cancer (PCa) or normal prostatic tissue. Two image datasets collected retrospectively were used in this study: 71 cases acquired with GE scanners (dataset A), and 59 cases acquired with Philips scanners (dataset B). Through a consensus histology- MR correlation review, 175 PCa and 108 normal-tissue ROIs were identified and drawn manually. Reference-tissue ROIs were selected in each case from the levator ani muscle, urinary bladder, and pubic bone. T2-weighted image SI was corrected as the ratio of the average T2-weighted image SI within an ROI to that of a reference-tissue ROI. Area under the receiver operating characteristic curve (AUC) was used to evaluate the effectiveness of T2-weighted image SIs for differentiation of PCa from normal-tissue ROIs. AUC (+/- standard error) for uncorrected T2-weighted image SIs was 0.78+/-0.04 (datasets A) and 0.65+/-0.05 (datasets B). AUC for corrected T2-weighted image SIs with respect to muscle, bladder, and bone reference was 0.77+/-0.04 (p=1.0), 0.77+/-0.04 (p=1.0), and 0.75+/-0.04 (p=0.8), respectively, for dataset A; and 0.81+/-0.04 (p=0.002), 0.78+/-0.04 (p<0.001), and 0.79+/-0.04 (p<0.001), respectively, for dataset B. Correction in reference to the levator ani muscle yielded the most consistent results between GE and Phillips images. Correction of T2-weighted image SI in reference to three types of extra-prostatic tissue can improve its effectiveness for differentiation of PCa from normal-tissue ROIs, and correction in reference to the levator ani muscle produces consistent T2-weighted image SIs between GE and Phillips MR images.

  4. Architectural differences in the anterior and middle compartments of the pelvic floor of young-adult and postmenopausal females.

    PubMed

    Wu, Yi; Dabhoiwala, Noshir F; Hagoort, Jaco; Tan, Li-Wen; Zhang, Shao-Xiang; Lamers, Wouter H

    2017-05-01

    The pelvic floor guards the passage of the pelvic organs to the exterior. The near-epidemic prevalence of incontinence in women continues to generate interest in the functional anatomy of the pelvic floor. However, due to its complex architecture and poor accessibility, the classical 'dissectional' approach has been unable to come up with a satisfactory description, so that many aspects of its anatomy continue to raise debate. For this reason, we opted for a 'sectional' approach, using the Chinese Visible Human project (four females, 21-35 years) and the Visible Human Project (USA; one female, 59 years) datasets to investigate age-related changes in the architecture of the anterior and middle compartments of the pelvic floor. The puborectal component of the levator ani muscle defined the levator hiatus boundary. The urethral sphincter complex consisted of a circular proximal portion (urethral sphincter proper), a sling that passed on the vaginal wall laterally to attach to the puborectal muscle (urethral compressor), and a circular portion that surrounded the distal urethra and vagina (urethrovaginal sphincter). The exclusive attachment of the urethral sphincter to soft tissues implies dependence on pelvic-floor integrity for optimal function. The vagina was circular at the introitus and gradually flattened between bladder and rectum. Well-developed fibrous tissue connected the inferior vaginal wall with urethra, rectum and pelvic floor. With eight-muscle insertions, the perineal body was a strong, irregular fibrous node that guarded the levator hiatus. Only loose areolar tissue comprising a remarkably well developed venous plexus connecting the middle and superior parts of the vagina with the lateral pelvic wall. The posterolateral boundary of the putative cardinal and sacrouterine ligaments coincided with the adventitia surrounding the mesorectum. The major difference between the young-adult and postmenopausal pelvic floor was the expansion of fat in between

  5. Relationships Between 3-Dimensional Transperineal Ultrasound Imaging and Digital Intravaginal Palpation Assessments of the Pelvic Floor Muscles in Women With and Without Provoked Vestibulodynia.

    PubMed

    Thibault-Gagnon, Stéphanie; Goldfinger, Corrie; Pukall, Caroline; Chamberlain, Susan; McLean, Linda

    2018-03-01

    Digital intravaginal palpation remains the favored method for clinical assessment of pelvic floor muscle (PFM) function in women; however, there is growing interest in using transperineal ultrasound imaging (TPUSI). TPUSI does not involve vaginal penetration, making it particularly relevant for PFM assessment in women with genito-pelvic pain and penetration disorders. To study the relations between measures of PFM morphology and function assessed using 3-dimensional (3D) TPUSI and PFM assessment through intravaginal palpation. 77 nulliparous premenopausal women with (n = 38) and without (n = 39) PVD participated. 3D TPUSI was used to measure levator hiatal dimensions at rest, at maximal voluntary contraction (MVC) of the PFMs, and at maximal Valsalva maneuver (MVM). Intravaginal palpation was used to assess PFM strength, PFM tone, PFM relaxation after contraction, and vaginal flexibility; each was scored using an ordinal grading scale. Ultrasound and palpation outcomes were compared using Spearman correlation coefficients and Kruskal-Wallis 1-way analyses of variance by rank. Outcomes included ultrasound measures of the levator hiatal area, anteroposterior diameter, and left-right transverse diameter at rest, at MVC, and at MVM; raw and relative changes in hiatal dimensions between rest and MVC and between rest and MVM; and palpation measures of PFM strength, tone, and relaxation after contraction, and vaginal flexibility. Weak to fair correlations were found between ultrasound and palpation measures. A smaller levator hiatus at rest was associated with greater PFM tone, less PFM relaxation, and less vaginal flexibility. Greater levator hiatal constriction and shortening of the hiatal anteroposterior diameter at MVC were associated with greater palpated PFM strength. Greater hiatal distention at MVM was associated with lower PFM tone and greater relaxation. 3D TPUSI and intravaginal palpation provide related but distinct information about PFM function in young

  6. Variations in Velopharyngeal Structure in Adults With Repaired Cleft Palate.

    PubMed

    Perry, Jamie L; Kotlarek, Katelyn J; Sutton, Bradley P; Kuehn, David P; Jaskolka, Michael S; Fang, Xiangming; Point, Stuart W; Rauccio, Frank

    2018-01-01

    The purpose of this study was to examine differences in velopharyngeal structures between adults with repaired cleft palate and normal resonance and adults without cleft palate. Thirty-six English-speaking adults, including 6 adults (2 males and 4 females) with repaired cleft palate (M = 32.5 years of age, SD = 17.4 years) and 30 adults (15 males and 15 females) without cleft palate (M = 23.3 years of age, SD = 4.1 years), participated in the study. Fourteen velopharyngeal measures were obtained on magnetic resonance images and compared between groups (cleft and noncleft). After adjusting for body size and sex effects, there was a statistically significant difference between groups for 10 out of the 14 velopharyngeal measures. Compared to those without cleft palate, participants with repaired cleft palate had a significantly shorter hard palate height and length, shorter levator muscle length, shorter intravelar segment, more acute levator angles of origin, shorter and thinner velum, and greater pharyngeal depth. Although significant differences were evident in the cleft palate group, individuals displayed normal resonance. These findings suggest that a wide variability in velopharyngeal anatomy can occur in the presence of normal resonance, particularly for those with repaired cleft palate. Future research is needed to understand how anatomic variability impacts function, such as during speech.

  7. [Physiology of the urethral sphincteric vesico-prostatic complex].

    PubMed

    Carmignani, L; Gadda, F; Dell'Orto, P; Ferruti, M; Grisotto, M; Rocco, F

    2001-09-01

    We propose a review of the literature about innervation and physiology of the urethral sphincteric complex. Parasympathetic innervation of the pelvic viscera comes from ventral branches of the sacral nerves (S2-S4). The orthosympathetic component derives from superior hypogastric plexus and runs down the hypogastric nerves to form the right and left pelvic plexus together with the parasympathetic component. The pelvic plexus is situated inferolaterally with respect to the rectum and runs on the surface of the levator ani muscle down to the prostatic apex. The pelvic plexus gives innervation to the rectum, the bladder, the prostate and the urethral sphincteric complex. The pelvic muscular floor is innervated by the somatic component (pudendal nerve) derived from the sacral branches (S2-S4). Bladder neck and smooth muscle urethral sphincter innervation is given mostly by the orthosympathetic component. The rhabdosphincter innervation comes from the pudendal nerve and from the pelvic plexus; its role in the continence mechanism is probably to give steady tonic urethral compression. Levator ani muscle takes part in the sphincteric complex with its anteromedial pubococcygeal portion. It plays its role strengthening the sphincteric tone during increase of the abdominal pressure or during active quick stop cessation of the urinary stream.

  8. A Study to Determine the Feasibility of Implementing Same-Day Surgery at Brooke Army Medical Center

    DTIC Science & Technology

    1989-02-01

    RECTAL MASSAGE (FOR LEVATOR SPASM) 9994 PROSTATIC MASSAGE z 9995 STRETCHING OF FORESKIN ci 9996 COLLECTION OF SPERM FOR ARTIFICIAL INSEMINATION > 9997...the same day. It can be performed in hospitals, in hospital satellites , in buildings adjacent to or near hospitals, or in independently operated...hospital’s structure but has m independent operating room recovery areas; 0 0 C 0 (3) Satellite --The program is based in a separate facility, m located off

  9. A Cross-Sectional Survey of the Association between Bilateral Topical Prostaglandin Analogue Use and Ocular Adnexal Features

    PubMed Central

    Shah, Mamta; Lee, Grace; Lefebvre, Daniel R.; Kronberg, Benjamin; Loomis, Stephanie; Brauner, Stacey C.; Turalba, Angela; Rhee, Douglas J.; Freitag, Suzanne K.; Pasquale, Louis R.

    2013-01-01

    We studied the relation between prostaglandin analogue use and ocular adnexal features. We used a prospective, cross-sectional study involving 157 current, 15 past, and 171 never users of prostaglandin analogues. Patients 50 years of age or older and without conditions affecting ocular adnexal anatomy underwent glaucoma medication use history, external digital photography and systematic external adnexal exam. Two masked readers assessed the digital photos for upper lid dermatochalasis and lower lid steatoblepharon using a validated grading scheme. Another masked clinical examiner also assessed upper lid ptosis, levator muscle function, and inferior scleral show. We performed ordinal logistic regression analysis accounting for multiple covariates to assess the relation between prostaglandin analogue use and adnexal features. Multivariable analyses indicated there was a 230-fold increased risk of incremental involution of dermatochalasis (odds ratio (OR)  =  2.30; 95% confidence interval (CI) 1.43–3.69; p = 5.44E-04) and a 249-fold increased risk of incremental loss of lower lid steatoblepharon (OR  =  2.49; 95% CI, 1.54–4.03; p =  1.98E-04) associated with current prostaglandin analogue use (bimatoprost 0.03%, travoprost 0.005%, or latanoprost 0.004%) versus prostaglandin analogue never or past users. Upper lid ptosis (OR  =  4.04; 95% CI, 2.43–6.72; p = 7.37E-08), levator dysfunction (OR =  7.51; 95% CI, 3.39–16.65; p = 6.74E-07) and lower lid retraction (OR = 2.60; 95% CI, 1.58–4.28; p = 1.72E-04) were highly associated with current prostaglandin analogue use versus prostaglandin analogue never or past users. The associations between prostaglandin analogue use and deepening of the upper lid sulci and between prostaglandin analogue use and loss of inferior periorbital fat are confirmed in this multivariable analysis. The associations between prostaglandin analogue use and levator muscle dysfunction and between

  10. Genetic Studies of Strabismus, Congenital Cranial Dysinnervation Disorders (CCDDs), and Their Associated Anomalies

    ClinicalTrials.gov

    2018-03-21

    Congenital Fibrosis of Extraocular Muscles; Duane Retraction Syndrome; Duane Radial Ray Syndrome; Mobius Syndrome; Brown Syndrome; Marcus Gunn Syndrome; Strabismus Congenital; Horizontal Gaze Palsy; Horizontal Gaze Palsy With Progressive Scoliosis; Facial Palsy; Facial Paresis, Hereditary, Congenital; Third Nerve Palsy; Fourth Nerve Palsy; Sixth Nerve Palsy; Synkinesis; Ocular Motility Disorders; Levator-Medial Rectus Synkinesis; Athabaskan Brainstem Dysgenesis; Tongue Paralysis; Ninth Nerve Disorder; Fifth Nerve Palsy; Seventh Nerve Palsy; Eleventh Nerve Disorder; Twelfth Nerve Disorder; Vagus Nerve Paralysis; Moebius Sequence

  11. Proceedings of Conference on 73 Easting: Lessons from Desert Storm Via Advanced Simulation Technology Held in Alexandria, Virginia on 27-29 August 1991

    DTIC Science & Technology

    1992-04-01

    fruits and vegetables , plentiful stocks of potatoes, fresh water and so forth. So they were doing all right. Q. Touchy area, but were you assisted by...34 to differentiate vegetation , roads, soils and depict special effects (e.g., dust clouds, explosions, smoke). Each pixel is assigned one of 4096 colors... vegetation and (di) roads. Lbind Featurcs. In ")L -era], land has bken modeled by digital eýlevation posts ona regular 125-meter ITEM gr-d. *he

  12. Effect of a worktable position on head and shoulder posture and shoulder muscles in manual material handling.

    PubMed

    Kim, Min-Hee; Yoo, Won-Gyu

    2015-06-05

    According to a recent research, manual working with high levels of static contraction, repetitive loads, or extreme working postures involving the neck and shoulder muscles causes an increased risk of neck and shoulder musculoskeletal disorders. We investigated the effects of the forwardly worktable position on head and shoulder angles and shoulder muscle activity in manual material handling tasks. The forward head and shoulder angles and the activity of upper trapezius, levator scapulae, and middle deltoid muscle activities of 15 workers were measured during performing of manual material handling in two tasks that required different forward head and shoulder angles. The second manual material task required a significantly increased forward head and shoulder angle. The upper trapezius and levator scapulae muscle activity in second manual material task was increased significantly compared with first manual material task. The middle deltoid muscle activity in second manual material task was not significantly different compared with first manual material task. Based on this result, the forward head and shoulder angles while performing manual work need to be considered in selection of the forward distance of a worktable form the body. The high level contractions of the neck and shoulder muscles correlated with neck and shoulder pain. Therefore, the forward distance of a worktable can be an important factor in preventing neck and shoulder pain in manual material handling workers.

  13. Ptosis assessment spectacles: a new method of measuring lid position and movement in children.

    PubMed

    Khandwala, Mona; Dey, Sarju; Harcourt, Cassie; Wood, Clive; Jones, Carole A

    2011-01-01

    Accurate assessment of eyelid position and movement is vital in planning the surgical correction of ptosis. Conventional measurements taken using a millimeter ruler are considered the gold standard, although in young children this can be a difficult procedure. The authors have designed ptosis assessment spectacles with a measuring millimeter scale marked on the center of the lens to facilitate accurate assessment of eyelid position and function in children. The purpose of the study was to assess the accuracy and reproducibility of eyelid measurement using these ptosis assessment spectacles. Fifty-two children aged 2-12 years were recruited in this study. Each child underwent 2 sets of measurements. The first was undertaken by an ophthalmologist in the conventional manner using a ruler, and the second set made with ptosis assessment spectacles. On each occasion the palpebral aperture, skin crease, and levator function were recorded in millimeters. A verbal analog scale was used to assess parent satisfaction with each method. Clinically acceptable reproducibility was shown with the ruler and the spectacles for all measurements: palpebral aperture, skin crease, and levator function. Parents significantly preferred the glasses for measurement, as compared with the ruler (p < 0.05). The spectacles are as accurate as conventional methods of measurement, but are easier to use. Children tolerate these spectacles well, and most parents preferred them to the ruler.

  14. [Acute anal pain].

    PubMed

    Pittet, Olivier; Demartines, Nicolas; Hahnloser, Dieter

    2013-07-01

    Acute anal pain is a common proctological problem. A detailed history together with the clinical examination are crucial for the diagnosis. An acute perianal vein thrombosis can be successfully excised within the first 72 hours. Acute anal fissures are best treated conservatively using stool regulation and topical medications reducing the sphincter spasm. A chronic anal fissure needs surgery. Perianal abscesses can very often be incised and drained in local anesthesia. Proctalgia fugax and the levator ani syndrome are exclusion diagnoses and are treated symptomatically.

  15. Treatment of proctalgia fugax with topical nitroglycerin: report of a case.

    PubMed

    Lowenstein, B; Cataldo, P A

    1998-05-01

    We report a single case of proctalgia fugax that responded to 0.3 percent nitroglycerin ointment. Case report. A single case of proctalgia fugax responded to topical application of 0.3 percent nitro glycerin ointment with no significant side effects. Nitroglycerin ointment is a newly described treatment for several painful anal conditions. We describe a single case of levator spasm or proctalgia fugax responding to topical application of nitroglycerin. This is only a single case report, and conclusive evidence awaits completion of a controlled clinical trial.

  16. MR-defecography in obstructed defecation syndrome (ODS): technique, diagnostic criteria and grading.

    PubMed

    Piloni, V; Tosi, P; Vernelli, M

    2013-10-01

    The aim of this study was to evaluate the use of a magnetic resonance (MR)-based classification system of obstructive defecation syndrome (ODS) to guide physicians in patient management. The medical records and imaging series of 105 consecutive patients (90 female, 15 male, aged 21-78 years, mean age 46.1 ± 5.1 years) referred to our center between April 2011 and January 2012 for symptoms of ODS were retrospectively examined. After history taking and a complete clinical examination, patients underwent MR imaging according to a standard protocol using a 0.35 T permanent field, horizontally oriented open-configuration magnet. Static and dynamic MR-defecography was performed using recognized parameters and well-established diagnostic criteria. Sixty-seven out of 105 (64 %) patients found the prone position more comfortable for the evacuation of rectal contrast while 10/105 (9.5 %) were unable to empty their rectum despite repeated attempts. Increased hiatus size, anterior rectocele and focal or extensive defects of the levator ani muscle were the most frequent abnormalities (67.6, 60.0 and 51.4 %, respectively). An MR-based classification was developed based on the combinations of abnormalities found: Grade 1 = functional abnormality, including paradoxical contraction of the puborectalis muscle, without anatomical defect affecting the musculo-fascial structures; Grade 2 = functional defect associated with a minor anatomical defect such as rectocele ≤ 2 cm in size and/or first-degree intussusception; Grade 3 = severe defects confined to the posterior anatomical compartment, including >2 cm rectocele, second- or higher-degree intussusception, full-thickness external rectal prolapse, poor mesorectal posterior fixation, rectal descent >5 cm, levator ani muscle rupture, ballooning of the levator hiatus and focal detachment of the endopelvic fascia; Grade 4 = combined defects of two or three pelvic floor compartments, including cystocele, hysterocele, enlarged urogenital

  17. Reevaluating Musculoskeletal Linkages in Suction-Feeding Fishes with X-Ray Reconstruction of Moving Morphology (XROMM).

    PubMed

    Camp, Ariel L; Brainerd, Elizabeth L

    2015-07-01

    Suction-feeding fishes encompass a vast diversity of morphologies and ecologies, but during feeding they all rely on musculoskeletal linkages and levers to transform the shortening of muscle into 3D expansion of the mouth cavity. To relate the shape of these skeletal elements to their function in expansion of the mouth, four-bar linkage models have been developed and widely used in studies of ecology, evolution, and development. However, we have lacked the ability to test the predictions of these 2D linkage models against the actual 3D motions of fishes' skulls. A new imaging method, X-ray Reconstruction of Moving Morphology (XROMM), now makes it possible to measure 3D skeletal motions relative to other bones within the head and relative to the fish's body, and thereby to examine directly the proposed linkages. We used XROMM to examine the opercular linkage, in which shortening of the levator operculi muscle is hypothesized to retract the operculum, and thereby the interoperculum and interoperculomandibular ligament to generate depression of the lower jaw about the quadratomandibular joint. XROMM animations of suction strikes in largemouth bass revealed that the operculum is indeed retracted relative to the suspensorium as the levator operculi muscle shortens and the jaw depresses. However, the four-bar model of this linkage overestimates the depression of the jaw by nearly a factor of two. Therefore, caution should be used in interpreting and applying the predictions of this linkage model. When we measured kinematics relative to the fish's body, we found that the operculum was relatively stable, whereas the suspensorium was elevated along with the neurocranium, pushing the quadratomandibular joint forward to produce depression of the jaw. Thus, it is the epaxial muscles elevating the neurocranium that powers depression of the jaw through the opercular linkage. However, the levator operculi muscle plays a crucial role in stabilizing the operculum to allow elevation

  18. Pelvic Floor Dynamics During High-Impact Athletic Activities: A Computational Modeling Study

    PubMed Central

    Dias, Nicholas; Peng, Yun; Khavari, Rose; Nakib, Nissrine A.; Sweet, Robert M.; Timm, Gerald W.; Erdman, Arthur G.; Boone, Timothy B.

    2017-01-01

    Background Stress urinary incontinence is a significant problem in young female athletes, but the pathophysiology remains unclear because of the limited knowledge of the pelvic floor support function and limited capability of currently available assessment tools. The aim of our study is to develop an advanced computer modeling tool to better understand the dynamics of the internal pelvic floor during highly transient athletic activities. Methods Apelvic model was developed based on high-resolution MRI scans of a healthy nulliparous young female. A jump-landing process was simulated using realistic boundary conditions captured from jumping experiments. Hypothesized alterations of the function of pelvic floor muscles were simulated by weakening or strengthening the levator ani muscle stiffness at different levels. Intra-abdominal pressures and corresponding deformations of pelvic floor structures were monitored at different levels of weakness or enhancement. Findings Results show that pelvic floor deformations generated during a jump-landing process differed greatly from those seen in a Valsalva maneuver which is commonly used for diagnosis in clinic. The urethral mobility was only slightly influenced by the alterations of the levator ani muscle stiffness. Implications for risk factors and treatment strategies were also discussed. Interpretation Results suggest that clinical diagnosis should make allowances for observed differences in pelvic floor deformations between a Valsalva maneuver and a jump-landing process to ensure accuracy. Urethral hypermobility may be a less contributing factor than the intrinsic sphincteric closure system to the incontinence of young female athletes. PMID:27886590

  19. ANMS-ESNM Position Paper and Consensus Guidelines On Biofeedback Therapy for Anorectal Disorders

    PubMed Central

    Rao, Satish S.C.; Benninga, Marc A; Bharucha, Adil E; Chiarioni, Giuseppe; Di Lorenzo, Carlo; Whitehead, William E

    2015-01-01

    Anorectal disorders such as dyssynergic defecation, fecal incontinence, levator ani syndrome and solitary rectal ulcer syndrome are common, and affect both the adult and pediatric populations. Although they are treated with several treatment approaches, over the last two decades, biofeedback therapy using visual and verbal feedback techniques has emerged as an useful option. Because it is safe, it is commonly recommended. However, the clinical efficacy of biofeedback therapy in adults and children is not clearly known, and there is a lack of critical appraisal of the techniques used and the outcomes of biofeedback therapy for these disorders. The American Neurogastroenterology and Motility Society and the European Society of Neurogastroenterology and Motility convened a task force to examine the indications, study performance characteristics, methodologies used and the efficacy of biofeedback therapy, and to provide evidence-based recommendations. Based on the strength of evidence, biofeedback therapy is recommended for the short term and long term treatment of constipation with dyssynergic defecation (Level I, Grade A), and for the treatment of fecal incontinence (Level II, Grade B). Biofeedback therapy may be useful in the short-term treatment of Levator Ani Syndrome with dyssynergic defecation (Level II, Grade B), and solitary rectal ulcer syndrome with dyssynergic defecation (Level III, Grade C), but the evidence is fair. Evidence does not support the use of biofeedback for the treatment of childhood constipation (Level 1, Grade D). PMID:25828100

  20. Pharmacokinetics and pharmacodynamics of LGD-3303 [9-chloro-2-ethyl-1-methyl-3-(2,2,2-trifluoroethyl)-3H-pyrrolo-[3,2-f]quinolin-7(6H)-one], an orally available nonsteroidal-selective androgen receptor modulator.

    PubMed

    Vajda, Eric G; López, Francisco J; Rix, Peter; Hill, Robert; Chen, Yanling; Lee, Kyoung-Jin; O'Brien, Z; Chang, William Y; Meglasson, Martin D; Lee, Yong-Hee

    2009-02-01

    Selective androgen receptor modulators (SARMs) are a new class of molecules in development to treat a variety of diseases. SARMs maintain the beneficial effects of androgens, including increased muscle mass and bone density, while having reduced activity on unwanted side effects. The mechanisms responsible for the tissue-selective activity of SARMs are not fully understood, and the pharmacokinetic (PK)/pharmacodynamic (PD) relationships are poorly described. Tissue-specific compound distribution potentially could be a mechanism responsible for apparent tissue selectivity. We examined the PK/PD relationship of a novel SARM, LGD-3303 [9-chloro-2-ethyl-1-methyl-3-(2,2,2-trifluoroethyl)-3H-pyrrolo[3,2-f]quinolin-7(6H)-one], in a castrated rat model of androgen deficiency. LGD-3303 has potent activity on levator ani muscle but is a partial agonist on the preputial gland and ventral prostate. LGD-3303 never stimulated ventral prostate above intact levels despite increasing plasma concentrations of compound. Tissue-selective activity was maintained when LGD-3303 was dosed orally or by continuous infusion, two routes of administration with markedly different time versus exposure profiles. Despite the greater muscle activity relative to prostate activity, local tissue concentrations of LGD-3303 were higher in the prostate than in the levator ani muscle. LGD-3303 has SARM properties that are independent of its pharmacokinetic profile, suggesting that the principle mechanism for tissue-selective activity is the result of altered molecular interactions at the level of the androgen receptor.

  1. Colonic motility in proctalgia fugax.

    PubMed

    Harvey, R F

    1979-10-06

    Intraluminal pressure recordings were obtained from the rectum and sigmoid colon in two patients experiencing attacks of proctalgia fugax. In each patient the pain appeared to result from contractions of the sigmoid colon, and not from spasm of the levator ani, rectal wall muscle, or anal sphincters, all of which have previously been suggested as the source of such pain. Proctalgia fugax therefore appears, at least in some patients, to be an unusual variant of the irritable bowel syndrome, in which pain is referred from the sigmoid colon to the rectum.

  2. Polar-phase indices of perioral muscle reciprocity during syllable production in Parkinson's disease.

    PubMed

    Chu, Shin Ying; Barlow, Steven M; Lee, Jaehoon; Wang, Jingyan

    2017-12-01

    This research characterised perioral muscle reciprocity and amplitude ratio in lower lip during bilabial syllable production [pa] at three rates to understand the neuromotor dynamics and scaling of motor speech patterns in individuals with Parkinson's disease (PD). Electromyographic (EMG) signals of the orbicularis oris superior [OOS], orbicularis oris inferior [OOI] and depressor labii inferioris [DLI] were recorded during syllable production and expressed as polar-phase notations. PD participants exhibited the general features of reciprocity between OOS, OOI and DLI muscles as reflected in the EMG during syllable production. The control group showed significantly higher integrated EMG amplitude ratio in the DLI:OOS muscle pairs than PD participants. No speech rate effects were found in EMG muscle reciprocity and amplitude magnitude across all muscle pairs. Similar patterns of muscle reciprocity in PD and controls suggest that corticomotoneuronal output to the facial nucleus and respective perioral muscles is relatively well-preserved in our cohort of mild idiopathic PD participants. Reduction of EMG amplitude ratio among PD participants is consistent with the putative reduction in the thalamocortical activation characteristic of this disease which limits motor cortex drive from generating appropriate commands which contributes to bradykinesia and hypokinesia of the orofacial mechanism.

  3. Androgen signaling in myocytes contributes to the maintenance of muscle mass and fiber type regulation but not to muscle strength or fatigue.

    PubMed

    Ophoff, Jill; Van Proeyen, Karen; Callewaert, Filip; De Gendt, Karel; De Bock, Katrien; Vanden Bosch, An; Verhoeven, Guido; Hespel, Peter; Vanderschueren, Dirk

    2009-08-01

    Muscle frailty is considered a major cause of disability in the elderly and chronically ill. However, the exact role of androgen receptor (AR) signaling in muscle remains unclear. Therefore, a postmitotic myocyte-specific AR knockout (mARKO) mouse model was created and investigated together with a mouse model with ubiquitous AR deletion. Muscles from mARKO mice displayed a marked reduction in AR protein (60-88%). Interestingly, body weights and lean body mass were lower in mARKO vs. control mice (-8%). The weight of the highly androgen-sensitive musculus levator ani was significantly reduced (-46%), whereas the weights of other peripheral skeletal muscles were not or only slightly reduced. mARKO mice had lower intra-abdominal fat but did not demonstrate a cortical or trabecular bone phenotype, indicating that selective ablation of the AR in myocytes affected male body composition but not skeletal homeostasis. Furthermore, muscle contractile performance in mARKO mice did not differ from their controls. Myocyte-specific AR ablation resulted in a conversion of fast toward slow fibers, without affecting muscle strength or fatigue. Similar results were obtained in ubiquitous AR deletion, showing lower body weight, whereas some but not all muscle weights were reduced. The percent slow fibers was increased, but no changes in muscle strength or fatigue could be detected. Together, our findings show that myocyte AR signaling contributes to the maintenance of muscle mass and fiber type regulation but not to muscle strength or fatigue. The levator ani weight remains the most sensitive and specific marker of AR-mediated anabolic action on muscle.

  4. Female Longitudinal Anal Muscles or Conjoint Longitudinal Coats Extend into the Subcutaneous Tissue along the Vaginal Vestibule: A Histological Study Using Human Fetuses

    PubMed Central

    Arakawa, Takashi; Abe, Hiroshi; Rodríguez-Vízquez, Jose Francisco; Murakami, Gen; Sugihara, Kenichi

    2013-01-01

    Purpose It is still unclear whether the longitudinal anal muscles or conjoint longitudinal coats (CLCs) are attached to the vagina, although such an attachment, if present, would appear to make an important contribution to the integrated supportive system of the female pelvic floor. Materials and Methods Using immunohistochemistry for smooth muscle actin, we examined semiserial frontal sections of 1) eleven female late-stage fetuses at 28-37 weeks of gestation, 2) two female middle-stage fetus (2 specimens at 13 weeks), and, 3) six male fetuses at 12 and 37 weeks as a comparison of the morphology. Results In late-stage female fetuses, the CLCs consistently (11/11) extended into the subcutaneous tissue along the vaginal vestibule on the anterior side of the external anal sphincter. Lateral to the CLCs, the external anal sphincter also extended anteriorly toward the vaginal side walls. The anterior part of the CLCs originated from the perimysium of the levator ani muscle without any contribution of the rectal longitudinal muscle layer. However, in 2 female middle-stage fetuses, smooth muscles along the vestibulum extended superiorly toward the levetor ani sling. In male fetuses, the CLCs were separated from another subcutaneous smooth muscle along the scrotal raphe (posterior parts of the dartos layer) by fatty tissue. Conclusion In terms of topographical anatomy, the female anterior CLCs are likely to correspond to the lateral extension of the perineal body (a bulky subcutaneous smooth muscle mass present in adult women), supporting the vaginal vestibule by transmission of force from the levator ani. PMID:23549829

  5. Blepharoplasty techniques in the management of orbito-temporal neurofibromatosis.

    PubMed

    Li, Jin; Lin, Ming; Shao, Chunyi; Ge, Shengfang; Fan, Xianqun

    2014-11-01

    We aimed to present blepharoplasty techniques we used for severe orbito-temporal neurofibromatosis (NF). A retrospective noncomparative single-center case study was undertaken on patients with orbito-temporal NF. Twenty-two patients with orbito-temporal NF treated at the Department of Ophthalmology of Shanghai Ninth People's Hospital between 2007 and 2011 participated in the study. They underwent a standard ophthalmologic assessment for orbito-temporal NF involving both the orbito-temporal soft tissue and bony orbits. The orbits were examined with three-dimensional computed tomography (CT) and all 22 patients underwent tumor debulking, blepharoplasty, and orbital reconstruction. We modified the conventional procedures. Our reconstructive techniques included eyelid reduction; lateral canthal reattachment; for patients with collapse of the lateral orbital margin, reconstruction of the orbital margin to be performed before reattaching the lateral canthus to the implanted titanium mesh; anterior levator resection; and frontalis suspension according to preoperative levator muscle function. Visual acuity, tumor recurrence, and postoperative palpebral fissure and orbital appearance were evaluated to assess outcomes. Acceptable cosmetic results were obtained in 22 patients after debulking of the orbito-temporal NF and surgical reconstruction. There was no loss of vision or visual impairment postoperatively. All patients did not display recrudescence after a follow-up period of >1 year. Three patients with residual ptosis were successfully treated with a second ptosis repair. We believe that the blepharoplasty techniques described in the treatment of orbito-palpebral NF may provide both functional and esthetic benefits. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. Surgical desensitisation of the mechanoreceptors in Müller's muscle relieves chronic tension-type headache caused by tonic reflexive contraction of the occipitofrontalis muscle in patients with aponeurotic blepharoptosis.

    PubMed

    Matsuo, Kiyoshi; Ban, Ryokuya

    2013-02-01

    Proprioceptively innervated intramuscular connective tissues in Müller's muscle function as exterior mechanoreceptors to induce reflex contraction of the levator and occipitofrontalis muscles. In aponeurotic blepharoptosis, since the levator aponeurosis is disinserted from the tarsus, stretching of the mechanoreceptors in Müller's muscle is increased even on primary gaze to induce phasic and tonic reflexive contraction of the occipitofrontalis muscle. It was hypothesised that in certain patients with aponeurotic blepharoptosis, the presence of tonic reflexive contraction of the occipitofrontalis muscle due to the sensitised mechanoreceptors in Müller's muscle, can cause chronic tension-type headache (CTTH) associated with occipitofrontalis tenderness. To verify this hypothesis, this study evaluated (1) what differentiates patients with CTTH from patients without CTTH, (2) how pharmacological contraction of Müller's smooth muscle fibres as a method for desensitising the mechanoreceptors in Müller's muscle affects electromyographic activity of the frontalis muscle, and (3) how surgical aponeurotic reinsertion to desensitise the mechanoreceptors in Müller's muscle electromyographically or subjectively affects activities of the occipitofrontalis muscle or CTTH. It was found that patients had sustained CTTH when light eyelid closure did not markedly reduce eyebrow elevation. However, pharmacological contraction of Müller's smooth muscle fibres or surgery to desensitise the mechanoreceptor electromyographically reduced the tonic contraction of the occipitofrontalis muscle on primary gaze and subjectively relieved aponeurotic blepharoptosis-associated CTTH. Over-stretching of the mechanoreceptors in Müller's muscle on primary gaze may induce CTTH due to tonic reflexive contraction of the occipitofrontalis muscle. Therefore, surgical desensitisation of the mechanoreceptors in Müller's muscle appears to relieve CTTH.

  7. A Contractile Network of Interstitial Cells of Cajal in the Supratarsal Mueller's Smooth Muscle Fibers With Sparse Sympathetic Innervation

    PubMed Central

    Yuzuriha, Shunsuke; Matsuo, Kiyoshi; Ban, Ryokuya; Yano, Shiharu; Moriizumi, Tetsuji

    2012-01-01

    Background: We previously reported that the supratarsal Mueller's muscle is innervated by both sympathetic efferent fibers and trigeminal proprioceptive afferent fibers, which function as mechanoreceptors-inducing reflexive contractions of both the levator and frontalis muscles. Controversy still persists regarding the role of the mechanoreceptors in Mueller's muscle; therefore, we clinically and histologically investigated Mueller's muscle. Methods: We evaluated the role of phenylephrine administration into the upper fornix in contraction of Mueller's smooth muscle fibers and how intraoperative stretching of Mueller's muscle alters the degree of eyelid retraction in 20 patients with aponeurotic blepharoptosis. In addition, we stained Mueller's muscle in 7 cadavers with antibodies against α-smooth muscle actin, S100, tyrosine hydroxylase, c-kit, and connexin 43. Results: Maximal eyelid retraction occurred approximately 3.8 minutes after administration of phenylephrine and prolonged eyelid retraction for at least 20 minutes after administration. Intraoperative stretching of Mueller's muscle increased eyelid retraction due to its reflexive contraction. The tyrosine hydroxylase antibody sparsely stained postganglionic sympathetic nerve fibers, whereas the S100 and c-kit antibodies densely stained the interstitial cells of Cajal (ICCs) among Mueller's smooth muscle fibers. A connexin 43 antibody failed to stain Mueller's muscle. Conclusions: A contractile network of ICCs may mediate neurotransmission within Mueller's multiunit smooth muscle fibers that are sparsely innervated by postganglionic sympathetic fibers. Interstitial cells of Cajal may also serve as mechanoreceptors that reflexively contract Mueller's smooth muscle fibers, forming intimate associations with intramuscular trigeminal proprioceptive fibers to induce reflexive contraction of the levator and frontalis muscles. PMID:22359687

  8. Pertinent anatomy and analysis for midface volumizing procedures.

    PubMed

    Surek, Christopher C; Beut, Javier; Stephens, Robert; Jelks, Glenn; Lamb, Jerome

    2015-05-01

    The study was conducted to construct an anatomically inspired midfacial analysis facilitating safe, accurate, and dynamic nonsurgical rejuvenation. Emphasis is placed on determining injection target areas and adverse event zones. Twelve hemifacial fresh cadavers were dissected in a layered fashion. Dimensional measurements between the midfacial fat compartments, prezygomatic space, mimetic muscles, and neurovascular bundles were used to develop a topographic analysis for clinical injections. A longitudinal line from the base of the alar crease to the medial edge of the levator anguli oris muscle (1.9 cm), lateral edge of the levator anguli oris muscle (2.6 cm), and zygomaticus major muscle (4.6 cm) partitions the cheek into two aesthetic regions. A six-step facial analysis outlines three target zones and two adverse event zones and triangulates the point of maximum cheek projection. The lower adverse event zone yields an anatomical explanation to inadvertent jowling during anterior cheek injection. The upper adverse event zone localizes the palpebral branch of the infraorbital artery. The medial malar target area isolates quadrants for anterior cheek projection and tear trough effacement. The middle malar target area addresses lid-cheek blending and superficial compartment turgor. The lateral malar target area highlights lateral cheek projection and locates the prezygomatic space. This stepwise analysis illustrates target areas and adverse event zones to achieve midfacial support, contour, and profile in the repose position and simultaneous molding of a natural shape during animation. This reproducible method can be used both procedurally and in record-keeping for midface volumizing procedures.

  9. Paravaginal defect: anatomy, clinical findings, and imaging

    PubMed Central

    Arenholt, Louise T.S.; Pedersen, Bodil Ginnerup; Glavind, Karin; Glavind-Kristensen, Marianne; DeLancey, John O.L.

    2017-01-01

    Introduction and Hypothesis The paravaginal defect has been a topic of active discussion concerning 1) what it is; 2) how to diagnose it; 3) its role in anterior vaginal wall prolapse; and 4) if and how to repair it. The aim of this article is to review the existing literature on the paravaginal defect and to discuss its role in the anterior vaginal wall support system, with an emphasis on anatomy and imaging. Methods Articles related to paravaginal defects were identified through a PUBMED search ending July 1, 2015. Results The support of the anterior vaginal wall is a complex system involving the levator ani muscle, the arcus tendineus fascia pelvis (ATFP), the pubocervical fascia, and the uterosacral/cardinal ligaments. Studies conclude that physical examination is inconsistent in detecting paravaginal defects. Ultrasound (US) and magnetic resonance imaging (MRI) have been used to describe patterns in the appearance of the vagina and bladder when a paravaginal defect is suspected. Different terms have been used (e.g. “sagging of bladder base,” “loss of tenting”), which all represent changes in the support of the pelvic floor but which could be due to both paravaginal defects and levator ani defects. Conclusion Paravaginal support plays a role in the support of the anterior vaginal wall, but we still do not know the degree to which it contributes to the development of prolapse. Both MRI and US are useful in the diagnosis of paravaginal defects, but further studies are needed to evaluate their use. PMID:27640064

  10. [Face replantation using labial artery for revascularization. Case report].

    PubMed

    de la Parra-Márquez, Miguel; Mondragón-González, Sergio; López-Palazuelos, Jaime; Naal-Mendoza, Norberto; Rangel-Flores, Jesús María

    2013-01-01

    Restoration of the face function and cosmetic appearance after a traumatic complex wound is a challenge for the plastic surgeon. Worldwide, few cases have been reported about face replantation. To present the case of the first partial face replantation reported in the national bibliography, using the labial artery for revascularization. On June 19th 2011, a 7 years old male presented to the emergency room of the Mexican Institute of Social Security at Monterrey, Mexico, 4 hours after a partial face amputation secondary to a dog bite. The amputated segment was composed of 75% of the upper lip, 33% of the lower lip, oral commissure and 75% of the left cheek. The labial coronary artery and vein were anastomosed with 11-0 nylon sutures and the miorraphy of the orbicularis oris, the depressor anguli oris and the depressor labii inferioris with 4-0 vycril sutures. Six months after the surgery, the functional and aesthetic outcomes were excellent with reestablishment of total labial continence and total recovery of articulation of words. amputations of any facial component should be initially managed with replantation. The function and cosmetics are better than any other technique of reconstruction. The labial coronary artery is an excellent choice for revascularization up to 25% of the face (lips and cheek).

  11. Dynamic 3T Pelvic Floor Magnetic Resonance Imaging in Women Progressing from the Nulligravida to Primiparous State

    PubMed Central

    Lockhart, Mark E.; Bates, G. Wright; Morgan, Desiree E.; Beasley, Timothy M.; Richter, Holly E.

    2017-01-01

    Introduction and Hypothesis To prospectively characterize dynamic pelvic 3Tesla magnetic resonance imaging (dp3T MRI) findings in nulligravida women and characterize changes 6 months after delivery in the same woman. Methods In this prospective study, nulligravida women seeking assisted reproductive technology for pregnancy were recruited. After physical examination by Pelvic Organ Prolapse Quantification (POP-Q), Brinks assessment and measures including the Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire-7, pre-pregnancy dp3T MRI at rest, with strain, and evacuation were performed. Assessments were repeated ≥6 months postpartum. Analysis included Welch and paired t-tests for continuous variables, Fisher’s Exact Test for differences in categorical outcomes, and paired t-tests for postpartum symptoms. Results Nineteen subjects (mean±SD age, 31±5 years) completed baseline clinical and dp3T MRI studies, 15 delivered and 10 (30.5±3 years) completed pre-pregnancy and post-delivery clinical and dp3T MRI assessments. There were no significant changes in scores of validated questionnaires (all p>0.05) or on POP-Q measures post-delivery. Two (20%) subjects without pre-pregnancy levator tears had tears on MRI post-delivery. MRI measures of pelvic organ descent were increased post-delivery. Seventeen pelvic soft tissue parameters increased by greater than 10% post-delivery including 5/70 (7.1%), 17/110 (15.5%), and 50/110 (45.5%) values exceeding thresholds at rest, strain, and evacuation, respectively. Conclusions Dynamic pelvic 3T Magnetic Resonance Imaging detected levator tears and increased pelvic organ descent, which can be directly attributed to pregnancy and delivery. PMID:28871385

  12. Differences in Pelvic Morphology Between Women With and Without Provoked Vestibulodynia.

    PubMed

    McLean, Linda; Thibault-Gagnon, Stephanie; Brooks, Kaylee; Goldfinger, Corrie; Pukall, Caroline; Chamberlain, Susan

    2016-06-01

    Pelvic morphology has been suggested to reflect increased tone and reduced strength of the pelvic floor muscles (PFMs) in women with provoked vestibulodynia (PVD) compared to healthy controls. We aimed to determine whether there are differences in pelvic morphology in the resting state, on maximum voluntary contraction (MVC), or on maximum effort Valsalva maneuver (MVM) between women with and without PVD. While imaged using ultrasound, 38 women with PVD and 39 controls relaxed their PFMs, performed 3 MVCs and performed 3 MVMs. Levator plate length (LPL), levator plate angle (LPA), and anorectal angle (ARA) were determined at rest, at MVC and at MVM. The displacement of the bladder neck (BN) on MVC and on MVM was also determined. Two-way ANCOVAs were used to evaluate the main effects of group and task, the interaction between group and task, and the effect of resting morphology on LPL, LPA, and ARA. A 2-way repeated-measures ANOVA was used to determine whether the groups differed in terms of BN displacement during the tasks. Women with PVD had smaller LPLs and LPAs than controls across all tasks. The significant group differences in LPL and LPA at MVC and MVM were no longer significant once the resting values were included as covariates in the models. Bladder neck displacement differed between the groups at MVM but not at MVC. Women with PVD display shorter LPL sand smaller LPAs than controls but their behavior does not differ when MVC and MVMs are performed. Our results do not support the hypothesis that women with PVD demonstrate abnormalities in PFM contractility on MVC or compliance on MVM. Copyright © 2016. Published by Elsevier Inc.

  13. Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

    PubMed

    Pomian, Andrzej; Majkusiak, Wojciech; Lisik, Wojciech; Tomasik, Paweł; Horosz, Edyta; Zwierzchowska, Aneta; Kociszewski, Jacek; Barcz, Ewa

    2018-06-01

    Obesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool. The present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12-18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria. Fifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m 2 after surgery (p < 0.001). Statistically significant higher position of the bladder neck at rest, during tension, and at Valsalva maneuver (p < 0.05) was shown after surgery. We did not demonstrate differences in bladder neck mobility and bladder neck elevation at tension after weight loss. Bariatric surgery is associated with a betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

  14. Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data?

    PubMed

    Wlaźlak, Edyta; Surkont, Grzegorz; Shek, Ka L; Dietz, Hans P

    2015-10-01

    It has been claimed that urethral hypermobility and resting urethral pressure can largely explain stress incontinence in women. In this study we tried to replicate these findings in an unselected cohort of women seen for urodynamic testing, including as many potential confounders as possible. This study is a retrospective analysis of data obtained from 341 women. They attended for urodynamic testing due to symptoms of pelvic floor dysfunction. We excluded from the analysis women with a history of previous anti-incontinence and prolapse surgery. All patients had a standardised clinical assessment, 4D transperineal pelvic floor ultrasound and multichannel urodynamic testing. Urodynamic stress incontinence (USI) was diagnosed by multichannel urodynamic testing. Its severity was subjectively graded as mild, moderate and severe. Candidate variables were: age, BMI, symptoms of prolapse, vaginal parity, significant prolapse (compartment-specific), levator avulsion, levator hiatal area, Oxford grading, midurethral mobility, maximum urethral pressure (MUP), maximum cough pressure and maximum Valsalva pressure reached. On binary logistic regression, the following parameters were statistically significant in predicting urodynamic stress incontinence: age (P=0.03), significant rectocele (P=0.02), max. abdominal pressure reached (negatively, P<0.0001), midurethral mobility (P=0.0004) and MUP (negatively, P<0.0001). On multivariate analysis, accounting for multiple interdependencies, the following predictors remained significant: max. abdominal pressure reached (negatively, P<0.0001), cough pressure (P=0.006), midurethral mobility (P=0.003) and MUP (negatively, P<0.0001), giving an R(2) of 0.24. Mid-urethral mobility and MUP are the main predictors of USI. Demographic and clinical data are at best weak predictors. Our results suggest the presence of major unrecognised confounders. Copyright © 2015. Published by Elsevier Ireland Ltd.

  15. Eustachian Tube Function.

    PubMed

    Ars, Bernard; Dirckx, Joris

    2016-10-01

    The fibrocartilaginous eustachian tube is part of a system of contiguous organs including the nose, palate, rhinopharynx, and middle ear cleft. The middle ear cleft consists of the tympanic cavity, which includes the bony eustachian tube (protympanum) and the mastoid gas cells system. The tympanic cavity and mastoid gas cells are interconnected and allow gaseous exchange and pressure regulation. The fibrocartilaginous eustachian tube is a complex organ consisting of a dynamic conduit with its mucosa, cartilage, surrounding soft tissue, peritubal muscles (ie, tensor and levator veli palatine, salpingopharyngeus and tensor tympani), and superior bony support (the sphenoid sulcus). Copyright © 2016 Elsevier Inc. All rights reserved.

  16. [Cleft palate repair with a combined method of mucosal flap pushback of the hard palate].

    PubMed

    Zhao, Z; Li, S; Xu, J

    1996-03-01

    From January of 1992, we applied a combined method to repair cleft palate in 20 patients and received satisfactory results. The method is characterized by pushing back the mucosal flap of the hard palate, a Z-plasty on the nasal mucosa, repositioning the levator muscle to lengthen the palate, circumferential pharyng oplasty using denervated extensor hallucis brevis muscle, without making relaxing incisions and elevating the mucoperiosteal flap, avoiding interference to the greater and lesser palatine vessels and nerves, without relaxing palatal aponeurosis. The advantages of this method are preserving the normal anatomy and function of the palate and nasopharyngeal cavity, improving the function of velopharyngeal closure and minimizing secondary deformities.

  17. Contractile properties of single permeabilized muscle fibers from congenital cleft palates and normal palates of Spanish goats.

    PubMed

    Hanes, Michael C; Weinzweig, Jeffrey; Kuzon, William M; Panter, Kip E; Buchman, Steven R; Faulkner, John A; Yu, Deborah; Cederna, Paul S; Larkin, Lisa M

    2007-05-01

    Analysis of the composition of muscle fibers constituent to a cleft palate could provide significant insight into the cause of velopharyngeal inadequacy. The authors hypothesized that levator veli palatini muscle dysfunction inherent to cleft palates could affect the timing and outcome of cleft palate repair. Single, permeabilized muscle fibers from levator veli palatini muscles of three normal (n = 19 fibers) and three chemically induced congenital cleft palates (n = 21 fibers) of 14-month-old goats were isolated, and contractile properties were evaluated. The maximum isometric force and rate constants of tension redevelopment (ktr) were measured, and the specific force and normalized power were calculated for each fiber. The ktr measures indicate that cleft fibers are predominantly fast-fatigable; normal fibers are slow fatigue-resistant: after a 10-minute isometric contraction, fibers from cleft palates had a loss of force 16 percent greater than that from normal palates (p = 0.0001). The cross-sectional areas of the fibers from cleft palates (2750 +/- 209 microm2) were greater (p = 0.05) than those from normal palates (2226 +/- 143 microm2). Specific forces did not differ between the two groups. Maximum normalized power of fibers from cleft palates (11.05 +/- 1.82 W/l) was greater (p = 0.0001) than fibers from normal palates (1.60 +/- 0.12 W/l). There are clear physiologic differences in single muscle fibers from cleft palates and normal palates: cleft palate fibers are physiologically fast, have greater fatigability, and have greater power production. Detection of functional and/or fiber type differences in muscles of cleft palates may provide preoperative identification of a patient's susceptibility to velopharyngeal inadequacy and permit early surgical intervention to correct this clinical condition.

  18. Pre-operative training induces changes in the histomorphometry and muscle function of the pelvic floor in patients with indication of radical prostatectomy.

    PubMed

    Ocampo-Trujillo, A; Carbonell-González, J; Martínez-Blanco, A; Díaz-Hung, A; Muñoz, C A; Ramírez-Vélez, R

    2014-01-01

    To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP). A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis. After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 μm(2)vs. 1,056 ± 844 μm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied. Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  19. Developed lower-positioned transverse ligament restricts eyelid opening and folding and determines Japanese as being with or without visible superior palpebral crease.

    PubMed

    Ban, Midori; Matsuo, Kiyoshi; Ban, Ryokuya; Yuzuriha, Shunsuke; Kaneko, Ai

    2013-01-01

    We have reported that a developed lower-positioned transverse ligament between the superior-medial orbital rim and the lateral orbital rim on the lateral horn in the lower orbital fat space antagonizes eyelid opening and folding in certain Japanese to produce narrow eye, no visible superior palpebral crease, and full eyelid. In this study, we confirmed relationship between development of the lower-positioned transverse ligament and presence of the superior palpebral crease. We evaluated whether (1) digital immobilization of eyebrow movement during eyelid opening and (2) a developed lower-positioned transverse ligament could classify Japanese subjects as being with or without visible superior palpebral crease. Digital immobilization of eyebrow movement restricted eyelid opening in all subjects without visible superior palpebral crease but did not restrict in any subject with visible superior palpebral crease. Macroscopic and microscopic evidence revealed that the lower-positioned transverse ligament behind the lower orbital septum in subjects without visible superior palpebral crease was significantly more developed than that in subjects with visible superior palpebral crease. Since a developed lower-positioned transverse ligament antagonizes opening and folding of the anterior lamella of the upper eyelid in subjects without visible superior palpebral crease, these individuals open their eyelids by lifting the eyebrow with the anterior lamella and the lower-positioned transverse ligament owing to increased tonic contraction of the frontalis muscle, in addition to the retractile force of the levator aponeurotic expansions. In subjects with visible superior palpebral crease, the undeveloped lower-positioned transverse ligament does not antagonize opening and folding of the anterior lamella, and so they open their eyelids by folding the anterior lamella on the superior palpebral crease via the retractile force of the levator aponeurotic expansions.

  20. Developed Lower-Positioned Transverse Ligament Restricts Eyelid Opening and Folding and Determines Japanese as Being With or Without Visible Superior Palpebral Crease

    PubMed Central

    Ban, Midori; Matsuo, Kiyoshi; Ban, Ryokuya; Yuzuriha, Shunsuke; Kaneko, Ai

    2013-01-01

    Introduction: We have reported that a developed lower-positioned transverse ligament between the superior-medial orbital rim and the lateral orbital rim on the lateral horn in the lower orbital fat space antagonizes eyelid opening and folding in certain Japanese to produce narrow eye, no visible superior palpebral crease, and full eyelid. In this study, we confirmed relationship between development of the lower-positioned transverse ligament and presence of the superior palpebral crease. Methods: We evaluated whether (1) digital immobilization of eyebrow movement during eyelid opening and (2) a developed lower-positioned transverse ligament could classify Japanese subjects as being with or without visible superior palpebral crease. Results: Digital immobilization of eyebrow movement restricted eyelid opening in all subjects without visible superior palpebral crease but did not restrict in any subject with visible superior palpebral crease. Macroscopic and microscopic evidence revealed that the lower-positioned transverse ligament behind the lower orbital septum in subjects without visible superior palpebral crease was significantly more developed than that in subjects with visible superior palpebral crease. Conclusions: Since a developed lower-positioned transverse ligament antagonizes opening and folding of the anterior lamella of the upper eyelid in subjects without visible superior palpebral crease, these individuals open their eyelids by lifting the eyebrow with the anterior lamella and the lower-positioned transverse ligament owing to increased tonic contraction of the frontalis muscle, in addition to the retractile force of the levator aponeurotic expansions. In subjects with visible superior palpebral crease, the undeveloped lower-positioned transverse ligament does not antagonize opening and folding of the anterior lamella, and so they open their eyelids by folding the anterior lamella on the superior palpebral crease via the retractile force of the levator

  1. Learning process for performing and analyzing 3D/4D transperineal ultrasound imaging and interobserver reliability study.

    PubMed

    Siafarikas, F; Staer-Jensen, J; Braekken, I H; Bø, K; Engh, M Ellström

    2013-03-01

    To evaluate the learning process for acquiring three- and four-dimensional (3D/4D) transperineal ultrasound volumes of the levator hiatus (LH) dimensions at rest, during pelvic floor muscle (PFM) contraction and on Valsalva maneuver, and for analyzing the ultrasound volumes, as well as to perform an interobserver reliability study between two independent ultrasound examiners. This was a prospective study including 22 women. We monitored the learning process of an inexperienced examiner (IE) performing 3D/4D transperineal ultrasonography and analyzing the volumes. The examination included acquiring volumes during three PFM contractions and three Valsalva maneuvers. LH dimensions were determined in the axial plane. The learning process was documented by estimating agreement between the IE and an experienced examiner (E) using the intraclass correlation coefficient. Agreement was calculated in blocks of 10 ultrasound examinations and analyzed volumes. After the learning process was complete the interobserver reliability for the technique was calculated between these two independent examiners. For offline analysis of the first 10 ultrasound volumes obtained by E, good to very good agreement between E and IE was achieved for all LH measurements except for the left and right levator-urethra gap and pubic arc. For the next 10 analyzed volumes, agreement improved for all LH measurements. Volumes that had been obtained by IE and E were then re-evaluated by IE, and good to very good agreement was found for all LH measurements indicating consistency in volume acquisition. The interobserver reliability study showed excellent ICC values (ICC, 0.81-0.97) for all LH measurements except the pubic arc (ICC = 0.67). 3D/4D transperineal ultrasound is a reliable technique that can be learned in a short period of time. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  2. Outcome of triple-tendon transfer, an Eden-Lange variant, to reconstruct trapezius paralysis.

    PubMed

    Elhassan, Bassem T; Wagner, Eric R

    2015-08-01

    This study describes the technique and evaluates the outcome of the triple-tendon (T3) transfer, an Eden-Lange variant, to the scapula to stabilize the scapulothoracic articulation in the treatment of symptomatic trapezius paralysis. T3 transfers were performed in 22 patients with a history of persistent trapezius paralysis secondary to spinal accessory nerve injury. The indications for surgery included shoulder pain and weakness and limited range of motion of the shoulder. The T3 transfer included transfer of the levator scapulae to the lateral aspect of the spine of the scapula, the rhomboid minor to the spine of the scapula just medial to the levator scapulae insertion, and the rhomboid major to the medial spine of the scapula, including all muscles bony insertions. At an average follow-up of 35 months, winging was corrected in all patients, with improvement of shoulder asymmetry. All patients had significant improvement of pain (P < .01) and range of motion, including active shoulder abduction that improved from an average of 71° preoperatively to 118° postoperatively (P < .02) and shoulder flexion from an average of 102° to 150° (P < .01). There were also significant improvements in aggregate Constant Shoulder Score (P < .01), subjective shoulder value (P < .01), and Disabilities of the Arm, Shoulder and Hand score (P < .01). All patients were very satisfied with the outcome of surgery. This study shows that the T3 transfer is effective in stabilizing the scapulothoracic articulation and restoring the function of the trapezius, and thus, in improving pain and shoulder function in patients with symptomatic trapezius paralysis. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Normal reference values of strength in pelvic floor muscle of women: a descriptive and inferential study.

    PubMed

    Chevalier, Francine; Fernandez-Lao, Carolina; Cuesta-Vargas, Antonio Ignacio

    2014-11-25

    To describe the clinical, functional and quality of life characteristics in women with Stress Urinary Incontinence (SUI). In addition, to analyse the relationship between the variables reported by the patients and those informed by the clinicians, and the relationship between instrumented variables and the manual pelvic floor strength assessment. Two hundred and eighteen women participated in this observational, analytical study. An interview about Urinary Incontinence and the quality of life questionnaires (EuroQoL-5D and SF-12) were developed as outcomes reported by the patients. Manual muscle testing and perineometry as outcomes informed by the clinician were assessed. Descriptive and correlation analysis were carried out. The average age of the subjects was (39.93 ± 12.27 years), (24.49 ± 3.54 BMI). The strength evaluated by manual testing of the right levator ani muscles was 7.79 ± 2.88, the strength of left levator ani muscles was 7.51 ± 2.91 and the strength assessed with the perineometer was 7.64 ± 2.55. A positive correlation was found between manual muscle testing and perineometry of the pelvic floor muscles (p < .001). No correlation was found between outcomes of quality of life reported by the patients and outcomes of functional capacity informed by the physiotherapist. A stratification of the strength of pelvic floor muscles in a normal distribution of a large sample of women with SUI was done, which provided the clinic with a baseline. There is a relationship between the strength of the pelvic muscles assessed manually and that obtained by a perineometer in women with SUI. There was no relationship between these values of strength and quality of life perceived.

  4. Characterisation of the pharmacological profile of desoxymethyltestosterone (Madol), a steroid misused for doping.

    PubMed

    Diel, P; Friedel, A; Geyer, H; Kamber, M; Laudenbach-Leschowsky, U; Schänzer, W; Thevis, M; Vollmer, G; Zierau, O

    2007-02-28

    Desoxymethyltestosterone (DMT), also known as Madol, is a steroid recently identified to be misused as a doping agent. Since, the knowledge of functions of this substance is rather limited, it was our aim to characterise the pharmacological profile of DMT and to identify potential adverse side effects. DMT was synthesised, its purity was confirmed and its biological activity was tested. The potency of Madol (DMT) to transactivate androgen receptor (AR) dependent reporter gene expression was two times lower as compared to dihydrotestosterone (DHT). Receptor binding tests demonstrate that DMT binds with high selectivity to the AR, binding to the progesterone receptor (PR) was low. In vivo experiments in orchiectomised rats demonstrated that treatment with DMT resulted only in a stimulation of the weight of the levator ani muscle; the prostate and seminal vesicle weights remained unaffected. Like testosterone, administration of DMT resulted in a stimulation of IGF-1 and myostatin mRNA expression in the gastrocnemius muscle. In the prostate proliferation was stimulated by TP (testosteronepropionate), but remained unaffected by DMT. Remarkably, treatment with DMT, in contrast to TP, resulted in a significant increase of the heart weight. In the liver, DMT slightly stimulates the expression of the tyrosine aminotransferase gene (TAT). Our results demonstrate that DMT is a potent AR agonist with an anabolic activity. Besides the levator ani weight, DMT also modulates the gene expression in the musculus gastrocnemius. The observed stimulation of TAT expression in the liver and the significant increase of the heart weight after DMT treatment can be taken as an indication for side effects. Summarizing these data it is obvious that DMT is a powerful anabolic steroid with selective androgen receptor modulators (SARM) like properties and some indications for toxic side effects. Therefore, there is a need for a strict control of a possible misuse.

  5. Assessment of pelvic floor muscle contraction with palpation, perineometry and transperineal ultrasound: a cross-sectional study.

    PubMed

    Volløyhaug, I; Mørkved, S; Salvesen, Ø; Salvesen, K Å

    2016-06-01

    To study the correlation between palpation, perineometry and transperineal ultrasound for assessment of pelvic floor muscle contraction and to define a contraction scale for ultrasound measurements. This was a cross-sectional study of 608 women examined with palpation of pelvic floor muscle contraction, using the Modified Oxford Scale, and measurement of the vaginal squeeze pressure with a vaginal balloon connected to a fiber-optic microtip transducer (perineometry). Transperineal ultrasound was used for measurements of levator hiatal area and anteroposterior (AP) diameter in the plane of minimal hiatal dimensions, at rest and on contraction. The pelvic floor muscle contraction was expressed as the percentage difference between values at rest and on contraction. Spearman's rank was used to test for correlation between the different methods of assessment. Significant correlations were found between all assessment methods (P < 0.001). Palpation correlated with perineometry (rs = 0.74) and with proportional change in hiatal area (rs = 0.67) and AP diameter (rs = 0.69) on ultrasound. Perineometry correlated with proportional change in hiatal area (rs = 0.60) and AP diameter (rs = 0.66) on ultrasound. We defined a contraction scale based on the proportional change in AP diameter. In this population, a change in AP diameter of < 7% corresponded to absence of contractions, 7-18% corresponded to weak contractions, 18-35% corresponded to normal contractions and > 35% corresponded to strong contractions. We found moderate to strong correlation between ultrasound measurements, palpation and perineometry for assessing pelvic floor muscle contraction. The proportional change in levator hiatal AP diameter was the ultrasound measurement with strongest correlation to palpation and perineometry and formed the basis for the contraction scale for ultrasound measurements. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley

  6. Anti-androgenic effects of S-40542, a novel non-steroidal selective androgen receptor modulator (SARM) for the treatment of benign prostatic hyperplasia.

    PubMed

    Nejishima, Hiroaki; Yamamoto, Noriko; Suzuki, Mika; Furuya, Kazuyuki; Nagata, Naoya; Yamada, Shizuo

    2012-10-01

    Selective androgen receptor modulators (SARMs) would provide alternative therapeutic agent for androgen-related diseases. We identified a tetrahydroquinoline (THQ) derivative, 1-(8-nitro-3a, 4, 5, 9b-tetrahydro-3H-cyclopenta[c]quinolin-4-yl) ethane-1, 2-diol (S-40542) as a novel SARM antagonist. Affinity for nuclear receptors of S-40542 was evaluated in receptor-binding studies. Androgen receptor (AR) transcriptional activity of S-40542 was investigated by luciferase reporter assay in DU145AR cells. Normal and benign prostatic hyperplasia (BPH) model rats were repeatedly treated with S-40542 and flutamide. The tissue weights of prostate and levator ani muscle as well as blood levels of testosterone and luteinizing hormone were measured. S-40542 bound to the AR with high affinity. S-40542 at relatively high concentrations increased the transcriptional activity. This agent also showed a concentration-dependent AR antagonistic action in the presence of 1 nM 5α-dihydrotestosterone. Repeated treatment with S-40542 and flutamide decreased dose-dependently the weights of the prostate to a similar extent. In contrast, the tissue weight-reducing effect by S-40542 treatment on the levator ani muscle was much weaker than that of flutamide. S-40542 had little effect on the blood level of testosterone and luteinizing hormone, whereas flutamide increased the level of both hormones. Furthermore, S-40542 decreased dose-dependently prostate weight of BPH rats. The current results indicate that S-40542 possesses the prostate-selective SARM activity, suggestive of clinical benefit against benign prostate hyperplasia. THQ compounds may be useful for the research of mode of action of SARMs and for the development of safe SARM antagonists. Copyright © 2012 Wiley Periodicals, Inc.

  7. 3D Topography of the Young Adult Anal Sphincter Complex Reconstructed from Undeformed Serial Anatomical Sections

    PubMed Central

    Wu, Yi; Dabhoiwala, Noshir F.; Hagoort, Jaco; Shan, Jin-Lu; Tan, Li-Wen; Fang, Bin-Ji; Zhang, Shao-Xiang; Lamers, Wouter H.

    2015-01-01

    Background Pelvic-floor anatomy is usually studied by artifact-prone dissection or imaging, which requires prior anatomical knowledge. We used the serial-section approach to settle contentious issues and an interactive 3D-pdf to make the results widely accessible. Method 3D reconstructions of undeformed thin serial anatomical sections of 4 females and 2 males (21–35y) of the Chinese Visible Human database. Findings Based on tendinous septa and muscle-fiber orientation as segmentation guides, the anal-sphincter complex (ASC) comprised the subcutaneous external anal sphincter (EAS) and the U-shaped puborectal muscle, a part of the levator ani muscle (LAM). The anococcygeal ligament fixed the EAS to the coccygeal bone. The puborectal-muscle loops, which define the levator hiatus, passed around the anorectal junction and inserted anteriorly on the perineal body and pubic bone. The LAM had a common anterior attachment to the pubic bone, but separated posteriorly into puborectal and “pubovisceral” muscles. This pubovisceral muscle was bilayered: its internal layer attached to the conjoint longitudinal muscle of the rectum and the rectococcygeal fascia, while its outer, patchy layer reinforced the inner layer. ASC contraction makes the ano-rectal bend more acute and lifts the pelvic floor. Extensions of the rectal longitudinal smooth muscle to the coccygeal bone (rectococcygeal muscle), perineal body (rectoperineal muscle), and endopelvic fascia (conjoint longitudinal and pubovisceral muscles) formed a “diaphragm” at the inferior boundary of the mesorectum that suspended the anorectal junction. Its contraction should straighten the anorectal bend. Conclusion The serial-section approach settled contentious topographic issues of the pelvic floor. We propose that the ASC is involved in continence and the rectal diaphragm in defecation. PMID:26305117

  8. Successful embolization of a enterocutaneous fistula tract with Onyx 34 following low anterior resection for rectal cancer.

    PubMed

    Rahimi, Hamza; Venbrux, Anthony C; Obias, Vincent

    2018-06-01

    Enterocutaneous fistulas (ECFs) can be one of the complications found after surgical intervention for rectal cancer. Interventional modalities consisting of surgical, endoscopic, and radiological methods are often implemented to treat postoperative symptomatic complications. We present the case of 61-year-old Caucasian man who presented to us with a recent diagnosis of rectal cancer that had invaded the levators as well as anteriorly into the prostate, and who underwent low anterior resection with a diverting loop ileostomy. The patient was found to have a persistent presacral abscess due to an ECF tract. This case highlights the off-label use of ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx 34) to seal an ECF.

  9. Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services.

    PubMed

    Dietz, H P; Pardey, J; Murray, H

    2015-01-01

    There is an increasing awareness of maternal somatic birth trauma, which affects many more women than previously thought, primarily in the form of anal sphincter and levator ani tears. Given that such trauma occurs in about one-third of all women giving birth vaginally for the first time, and given that it has serious long-term consequences, it should be audited by all maternity services with a view to providing remedial therapy to delay or prevent subsequent morbidity, and to facilitate practice improvement. The increasing availability of modern imaging equipment and the skills of using it for pelvic floor assessment means that it is now becoming possible to provide such services postnatally.

  10. Insect-computer hybrid legged robot with user-adjustable speed, step length and walking gait.

    PubMed

    Cao, Feng; Zhang, Chao; Choo, Hao Yu; Sato, Hirotaka

    2016-03-01

    We have constructed an insect-computer hybrid legged robot using a living beetle (Mecynorrhina torquata; Coleoptera). The protraction/retraction and levation/depression motions in both forelegs of the beetle were elicited by electrically stimulating eight corresponding leg muscles via eight pairs of implanted electrodes. To perform a defined walking gait (e.g., gallop), different muscles were individually stimulated in a predefined sequence using a microcontroller. Different walking gaits were performed by reordering the applied stimulation signals (i.e., applying different sequences). By varying the duration of the stimulation sequences, we successfully controlled the step frequency and hence the beetle's walking speed. To the best of our knowledge, this paper presents the first demonstration of living insect locomotion control with a user-adjustable walking gait, step length and walking speed. © 2016 The Author(s).

  11. Insect–computer hybrid legged robot with user-adjustable speed, step length and walking gait

    PubMed Central

    Cao, Feng; Zhang, Chao; Choo, Hao Yu

    2016-01-01

    We have constructed an insect–computer hybrid legged robot using a living beetle (Mecynorrhina torquata; Coleoptera). The protraction/retraction and levation/depression motions in both forelegs of the beetle were elicited by electrically stimulating eight corresponding leg muscles via eight pairs of implanted electrodes. To perform a defined walking gait (e.g. gallop), different muscles were individually stimulated in a predefined sequence using a microcontroller. Different walking gaits were performed by reordering the applied stimulation signals (i.e. applying different sequences). By varying the duration of the stimulation sequences, we successfully controlled the step frequency and hence the beetle's walking speed. To the best of our knowledge, this paper presents the first demonstration of living insect locomotion control with a user-adjustable walking gait, step length and walking speed. PMID:27030043

  12. Localization of brain-derived neurotrophic factor, neurotrophin-4, tropomyosin-related kinase b receptor, and p75 NTR receptor by high-resolution immunohistochemistry on the adult mouse neuromuscular junction.

    PubMed

    Garcia, Neus; Tomàs, Marta; Santafe, Manel M; Lanuza, M Angel; Besalduch, Nuria; Tomàs, Josep

    2010-03-01

    Neurotrophins and their receptors, the trk receptor tyrosine kinases (trks) and p75(NTR), are differentially expressed among the cell types that make up synapses. It is important to determine the precise location of these molecules involved in neurotransmission. Here we use immunostaining and Western blotting to study the localization and expression of neurotrophin brain-derived neurotrophic factor (BDNF) and neurotrophin-4 (NT-4) and the receptors tropomyosin-related kinase b (trkB) and p75(NTR) at the adult neuromuscular junction. Our confocal immunofluorescence results on the whole mounts of the mouse Levator auris longus muscle and on semithin cross-sections showed that BDNF, NT-4, trkB, and p75(NTR) were localized on the three cells in the neuromuscular synapse (motor axons, post-synaptic muscle and Schwann cells).

  13. The occult submucous cleft palate.

    PubMed

    Kaplan, E N

    1975-10-01

    We have studied 41 patients with classic submucous cleft and 32 cases with occult submucous cleft. Both groups have the same anatomic abnormality that leads to velar dysfunction-the insertion of the palate muscles onto the hard palate rather than onto the midline soft palate raphe. However, the occult submucous cleft palate does not have the classic triad of bifid uvula, hard palate bony notch, and furrow in the midline of the soft palate. Characteristic facial features, cephalmetric x-rays, and cine voice studies can help make a presumptive diagnosis of occult submucous cleft palate. Surgical management includes a diagnostic palate exploration to identify muscle configuration followed by levator muscle sling reconstruction, palate pushback, and pharyngeal flap. Excellent speech results are obtained except with patients having palate paresis.

  14. Study of relationship between clinical factors and velopharyngeal closure in cleft palate patients

    PubMed Central

    Chen, Qi; Zheng, Qian; Shi, Bing; Yin, Heng; Meng, Tian; Zheng, Guang-ning

    2011-01-01

    BACKGROUND: This study was carried out to analyze the relationship between clinical factors and velopharyngeal closure (VPC) in cleft palate patients. METHODS: Chi-square test was used to compare the postoperative velopharyngeal closure rate. Logistic regression model was used to analyze independent variables associated with velopharyngeal closure. RESULTS: Difference of postoperative VPC rate in different cleft types, operative ages and surgical techniques was significant (P=0.000). Results of logistic regression analysis suggested that when operative age was beyond deciduous dentition stage, or cleft palate type was complete, or just had undergone a simple palatoplasty without levator veli palatini retropositioning, patients would suffer a higher velopharyngeal insufficiency rate after primary palatal repair. CONCLUSIONS: Cleft type, operative age and surgical technique were the contributing factors influencing VPC rate after primary palatal repair of cleft palate patients. PMID:22279464

  15. Chronic perineal pain: current pathophysiological aspects, diagnostic approaches and treatment.

    PubMed

    Andromanakos, Nikolaos P; Kouraklis, Grigorios; Alkiviadis, Kostakis

    2011-01-01

    Chronic perineal pain is the anorectal and perineal pain without underlying organic disease, anorectal or endopelvic, which has been excluded by careful physical examination, radiological and endoscopic investigations. A variety of neuromuscular disorders of the pelvic floor lead to the different pathological conditions such as anorectal incontinence, urinary incontinence and constipation of obstructed defecation, sexual dysfunction and pain syndromes. The most common functional disorders of the pelvic floor muscles, accompanied by perineal pain are levator ani syndrome, proctalgia fugax, myofascial syndrome and coccygodynia. In the diagnosis of these syndromes, contributing to a thorough history, physical examination, selected specialized investigations and the exclusion of organic disease with proctalgia is carried out. Accurate diagnosis of the syndromes helps in choosing an appropriate treatment and in avoiding unnecessary and ineffective surgical procedures, which often are performed in an attempt to alleviate the patient's symptoms.

  16. Occlusion therapy of unilateral amblyopia with botulinum toxin induced ptosis.

    PubMed

    Halkiadakis, Ioannis; Iliaki, Olga; Kalyvianaki, Maria I; Tsilimbaris, Miltiadis K

    2007-01-01

    In order to evaluate the role of botulinum toxin induced ptosis as an occlusion method to treat unilateral deep strabismic amblyopia in two uncooperative children, we injected 0.2 ml of diluted botulinum toxin in the levator palpaebrae; low sedation was necessary in one of the two children. In both cases a marked ptosis was achieved, which lasted about four weeks and then gradually resolved completely. The visual acuity of the ablyopic eye increased in both children, making patching easy thereafter. One child developed amblyopia in the injected eye, which was handled successfully using part-time occlusion. No other side effects were noted. Whether this new method could be a simple, safe and effective alternative method of occlusion for the treatment of deep amblyopia in uncooperative children needs to be proven with a larger series of children.

  17. [Cayler syndrome: A case report and review of the literature].

    PubMed

    Bellaiche, J; Correia, N; Bouche Pillon Persyn, M A; Chiriac, S; Bodin, F; François, C

    2016-08-01

    Facial asymmetries to the tears are rare. We report a pediatric original case that may fall within the framework of a Cayler syndrome. Through its clinical presentation, we will discuss differential diagnoses, associated forms, its etiology, and its management. At the maternity unit, in a male infant, after vaginal delivery at term without extraction, was discovered a lack of mobility of the labial commissure on the right side, only when crying. The rest of the examination was unremarkable, except ipsilateral microtia. Genetically, karyotype was 46,XY, 22q11 without microdeletion. The head and neck MRI and echocardiogram were normal. Asymmetry with tears has been described in the literature, through association with microdeletion 22q11 syndrome. The originality of this case was the presence of an isolated muscle abnormality. Muscles affected by this syndrome are: Musculus depressor labii inferioris, the Depressor anguli oris, and Mentalis musculus. The three muscles can be affected concomitantly. Isolated involvment of the Depressor anguli oris muscle has also been described. The mechanical dysfunction can be either linked to muscle innervation agenesis or to a defect thereof. There is no specific treatment. The symptoms improve with age by decreasing the frequency of crying. However, it is important to know this pathology in order to seek an optimum balance further in search of associated abnormalities (FISH 22q11, cardiac Doppler ultrasound) but also to educate, to reassure families often worried by the situation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (manual) and white-collar (office) workers.

    PubMed

    Fernández-de-las-Peñas, César; Gröbli, Christian; Ortega-Santiago, Ricardo; Fischer, Christine Stebler; Boesch, Daniel; Froidevaux, Philippe; Stocker, Lilian; Weissmann, Richard; González-Iglesias, Javier

    2012-07-01

    To describe the prevalence and referred pain area of trigger points (TrPs) in blue-collar (manual) and white-collar (office) workers, and to analyze if the referred pain pattern elicited from TrPs completely reproduces the overall spontaneous pain pattern. Sixteen (62% women) blue-collar and 19 (75% women) white-collar workers were included in this study. TrPs in the temporalis, masseter, upper trapezius, sternocleidomastoid, splenius capitis, oblique capitis inferior, levator scapulae, scalene, pectoralis major, deltoid, infraspinatus, extensor carpi radialis brevis and longus, extensor digitorum communis, and supinator muscles were examined bilaterally (hyper-sensible tender spot within a palpable taut band, local twitch response with snapping palpation, and elicited referred pain pattern with palpation) by experienced assessors blinded to the participants' condition. TrPs were considered active when the local and referred pain reproduced any symptom and the patient recognized the pain as familiar. The referred pain areas were drawn on anatomic maps, digitized, and measured. Blue-collar workers had a mean of 6 (SD: 3) active and 10 (SD: 5) latent TrPs, whereas white-collar workers had a mean of 6 (SD: 4) active and 11 (SD: 6) latent TrPs (P>0.548). No significant differences in the distribution of active and latent TrPs in the analyzed muscles between groups were found. Active TrPs in the upper trapezius, infraspinatus, levator scapulae, and extensor carpi radialis brevis muscles were the most prevalent in both groups. Significant differences in referred pain areas between muscles (P<0.001) were found; pectoralis major, infraspinatus, upper trapezius, and scalene muscles showed the largest referred pain areas (P<0.01), whereas the temporalis, masseter, and splenius capitis muscles showed the smallest (P<0.05). The combination of the referred pain from TrPs reproduced the overall clinical pain area in all participants. Blue-collar and white-collar workers

  19. The longitudinal fibromuscular component of the soft palate in the fifteen-week human fetus: musculus uvulae and palatine raphe.

    PubMed

    Langdon, H L; Klueber, K

    1978-10-01

    The structural relationships of the longitudinal fibromuscular component of the soft palate (musculus uvulae and raphe) were studied using histologic sections from 19 early human fetal specimens. Musculus uvulae arises in association with the palatine aponeurosis near the beginning of the second quadrant of the velum, follows a sigmoid course, and terminates near the base of the uvula. In addition, an occasional muscular loop may arise from the bony palate, arch downwards, and then recur into the uvular muscle. A complex relationship exists between the raphe in the velum and several palatal muscles. With regard to musculus uvulae, small muscular bundles arise from the raphe to embrace the muscle near its crest. These branches may aid in contouring the dorsal surface of the velum in the region of the levator eminence to complement the surface of the posterior pharyngeal wall and thus enhance the efficiency of the velopharyngeal seal.

  20. Identification of Control Parameters for Brass Player’s Embouchure by Measuring Contact Pressure on the Teeth Buccal Surface

    NASA Astrophysics Data System (ADS)

    Kourakata, Itaru; Moriyama, Kozo; Hara, Toshiaki

    For the technical improvement for brass instrument players it is important to obtain the detailed control parameters for embouchure building. While many investigators have reported the preliminary data on the muscle behavior, the precise aspects are unrevealed so far. The purpose of the present paper is to study dynamic perioral muscle behavior of French horn players and to investigate their lip valve function by measuring the contact pressure on teeth buccal surface during playing. It was shown from the experimental results that the advanced players contracted depressor angulioris and levator angulioris especially for high tone playing. It is considered that the combined contraction by these muscles contributes to forming smaller lip aperture being suitable to produce higher tones. Inversely a strong contraction of m. buccinator, which is widely believed to work to give hard tension to player’s lip, was observed insignificantly in the advanced players.

  1. The effect of cleft palate repair on contractile properties of single permeabilized muscle fibers from congenitally cleft goat palates.

    PubMed

    Hanes, Michael C; Weinzweig, Jeffrey; Panter, Kip E; McClellan, W Thomas; Caterson, Stefanie A; Buchman, Steven R; Faulkner, John A; Yu, Deborah; Cederna, Paul S; Larkin, Lisa M

    2008-02-01

    Inherent differences in the levator veli palatini (LVP) muscle of cleft palates before palatoplasty may play a role in persistent postrepair velopharyngeal insufficiency (VPI). Contractile properties of LVP muscle fibers were analyzed from young (2-month) normal (YNP), young congenitally cleft (YCP) and again on the same YCP subjects 6 months after palatoplasty, mature repaired palate (MRP). The cross-sectional area and rate of force development (ktr) were measured. Specific force (sF(0)) and normalized power (nP(max)) were calculated. Using k(tr) to determine fiber type composition, YNP was 44% type 1 and 56% type 2, while YCP was 100% type 2. Two MRP subjects shifted to 100% type 1; 1 demonstrated increased resistance to fatigue. No differences in sF(0) were observed. nP(max) increased with presence of type 2 fibers. The persistent state of type 2 fibers following palatoplasty leads to increased fatigue in the LVP of MRP subjects and may cause VPI symptoms.

  2. Biomechanical analysis of the circular friction hand massage.

    PubMed

    Ryu, Jeseong; Son, Jongsang; Ahn, Soonjae; Shin, Isu; Kim, Youngho

    2015-01-01

    A massage can be beneficial to relieve muscle tension on the neck and shoulder area. Various massage systems have been developed, but their motions are not uniform throughout different body parts nor specifically targeted to the neck and shoulder areas. Pressure pattern and finger movement trajectories of the circular friction hand massage on trapezius, levator scapulae, and deltoid muscles were determined to develop a massage system that can mimic the motion and the pressure of the circular friction massage. During the massage, finger movement trajectories were measured using a 3D motion capture system, and finger pressures were simultaneously obtained using a grip pressure sensor. Results showed that each muscle had different finger movement trajectory and pressure pattern. The trapezius muscle experienced a higher pressure, longer massage time (duration of pressurization), and larger pressure-time integral than the other muscles. These results could be useful to design a better massage system simulating human finger movements.

  3. Clinical Significance of an Unusual Variation

    PubMed Central

    Murugan, M. Senthil; Sudha, R.; Bhargavan, Rajesh

    2016-01-01

    The infrahyoid muscles are involved in vocalisation and swallowing; among these, the sternothyroid muscle is derived from the common primitive sheet. The improper differentiation of this muscle may therefore result in morphological variations. We report an unusual variation found during the dissection of a 65-year-old male cadaver at the Sri Manakula Vinayagar Medical College, Madagadipet, Pondicherry, India, in 2015. An anomalous belly of the right sternothyroid muscle was observed between the internal jugular (IJ) vein and the internal carotid artery with an additional insertion into the tympanic plate and petrous part of the temporal bone and the presence of a levator glandulae thyroideae muscle. The anomalous muscle may compress the IJ vein if it is related to the neurovascular structures of neck; hence, knowledge of variations of the infrahyoid muscles can aid in the evaluation of IJ vein compression among patients with idiopathic symptoms resulting from venous congestion. PMID:28003898

  4. Congenital multiple cranial neuropathies: Relevance of orofacial electromyography in infants.

    PubMed

    Renault, Francis; Flores-Guevara, Roberto; Baudon, Jean-Jacques; Vazquez, Marie-Paule

    2015-11-01

    The aim of this study was to assess diagnoses and outcomes of infants with 2 or more cranial neuropathies identified using orofacial electromyography (EMG). This retrospective study involved 90 patients. Diagnoses took into account clinical, radiological, and genetic data. EMG examined the orbicularis oculi, genioglossus, and levator veli palatini muscles, and blink responses. To evaluate outcome, neurological disability, respiratory complications, and feeding difficulties were recorded. The patients had malformation syndromes (59), encephalopathies (29), or no underlying disorders (2). Neurogenic EMG signs were detected in a mean of 4 muscles, reflecting a mean of 3 affected nerves. EMG identified a higher number of neuropathies than clinical examination alone (82 vs. 31, facial; 56 vs. 2, pharyngeal; 25 vs. 3, hypoglossal). Poor outcome and death were more frequent when EMG identified ≥4 affected nerves (P = 0.02). EMG highlights multiple cranial neuropathies that can be clinically silent in infants with malformation syndromes or encephalopathies. © 2015 Wiley Periodicals, Inc.

  5. [Steinert myotonic dystrophy and blepharoptosis surgery: 9 case reports].

    PubMed

    Karim, A; Schapiro, D; Morax, S

    2003-01-01

    Steinert myopathic dystrophy is a generalized, hereditary disease with bone, muscular, heart and ocular involvement. This is a retrospective study of nine patients with significant blepharoptosis due to Steinert disease, who were treated at the Adolphe de Rothschild Ophthalmology Foundation over a period of 5 years. Ptosis was symmetric and major in all cases with poor levator excursion. Severity criteria were an absence of the Bell phenomenon and diminished orbicularis tone. A frontalis suspension was performed in eight cases with intentional undercorrection. The outcome was favorable in all cases, 2 with a slight overcorrection underwent a second operation conclusion: Surgical treatment of ptosis in Steinert disease is difficult because of a risk of lagophthalmic, keratopathy due to the severity of the disease, an absence of the Bell phenomenon and ophthalmoplegia. This surgery must be undertaken with caution, most often using a frontalis suspension. Undercorrection must be systematic, with the single goal of freeing the pupil in the primary position.

  6. Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade.

    PubMed

    Valasek, Petr; Theis, Susanne; Krejci, Eliska; Grim, Milos; Maina, Flavio; Shwartz, Yulia; Otto, Anthony; Huang, Ruijin; Patel, Ketan

    2010-04-01

    The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage-tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin.

  7. Clinical anatomy of fecal incontinence in women.

    PubMed

    Kadam-Halani, Priyanka K; Arya, Lily A; Andy, Uduak U

    2017-10-01

    Fecal incontinence is a devastating condition that has a severe impact on quality of life. This condition disproportionately affects women and its incidence is increasing with the aging United States population. Fecal continence is maintained by coordination of a functioning anal sphincter complex, intact sensation of the anorectum, rectal compliance, and the ability to consciously control defecation. Particularly important are the puborectalis sling of the levator ani muscle complex and intact innervation of the central and peripheral nervous systems. An understanding of the intricate anatomy required to maintain continence and regulate defecation will help clinicians to provide appropriate medical and surgical management and diminish the negative impact of fecal incontinence. In this article, we describe the anatomic and neural basis of fecal continence and normal defecation as well as changes that occur with fecal incontinence in women. Clin. Anat. 30:901-911, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  8. Abelson tyrosine-protein kinase 2 regulates myoblast proliferation and controls muscle fiber length

    PubMed Central

    Lee, Jennifer K; Hallock, Peter T

    2017-01-01

    Muscle fiber length is nearly uniform within a muscle but widely different among different muscles. We show that Abelson tyrosine-protein kinase 2 (Abl2) has a key role in regulating myofiber length, as a loss of Abl2 leads to excessively long myofibers in the diaphragm, intercostal and levator auris muscles but not limb muscles. Increased myofiber length is caused by enhanced myoblast proliferation, expanding the pool of myoblasts and leading to increased myoblast fusion. Abl2 acts in myoblasts, but as a consequence of expansion of the diaphragm muscle, the diaphragm central tendon is reduced in size, likely contributing to reduced stamina of Abl2 mutant mice. Ectopic muscle islands, each composed of myofibers of uniform length and orientation, form within the central tendon of Abl2+/− mice. Specialized tendon cells, resembling tendon cells at myotendinous junctions, form at the ends of these muscle islands, suggesting that myofibers induce differentiation of tendon cells, which reciprocally regulate myofiber length and orientation. PMID:29231808

  9. Abelson tyrosine-protein kinase 2 regulates myoblast proliferation and controls muscle fiber length.

    PubMed

    Lee, Jennifer K; Hallock, Peter T; Burden, Steven J

    2017-12-12

    Muscle fiber length is nearly uniform within a muscle but widely different among different muscles. We show that Abelson tyrosine-protein kinase 2 (Abl2) has a key role in regulating myofiber length, as a loss of Abl2 leads to excessively long myofibers in the diaphragm, intercostal and levator auris muscles but not limb muscles. Increased myofiber length is caused by enhanced myoblast proliferation, expanding the pool of myoblasts and leading to increased myoblast fusion. Abl2 acts in myoblasts, but as a consequence of expansion of the diaphragm muscle, the diaphragm central tendon is reduced in size, likely contributing to reduced stamina of Abl2 mutant mice. Ectopic muscle islands, each composed of myofibers of uniform length and orientation, form within the central tendon of Abl2 +/- mice. Specialized tendon cells, resembling tendon cells at myotendinous junctions, form at the ends of these muscle islands, suggesting that myofibers induce differentiation of tendon cells, which reciprocally regulate myofiber length and orientation.

  10. Assessment of Speech in Primary Cleft Palate by Two-layer Closure (Conservative Management)

    PubMed Central

    Jain, Harsha; Rao, Dayashankara; Sharma, Shailender; Gupta, Saurabh

    2012-01-01

    Treatment of the cleft palate has evolved over a long period of time. Various techniques of cleft palate repair that are practiced today are the results of principles learned through many years of modifications. The challenge in the art of modern palatoplasty is no longer successful closure of the cleft palate but an optimal speech outcome without compromising maxillofacial growth. Throughout these periods of evolution in the treatment of cleft palate, the effectiveness of various treatment protocols has been challenged by controversies concerning speech and maxillofacial growth. In this article we have evaluated the results of Pinto's modification of Wardill–Kilner palatoplasty without radical dissection of the levator veli palitini muscle on speech and post-op fistula in two different age groups in 20 patients. Preoperative and 6-month postoperative speech assessment values indicated that two-layer palatoplasty (modified Wardill–Kilner V-Y pushback technique) without an intravelar veloplasty technique was good for speech. PMID:23066454

  11. Assessment of Speech in Primary Cleft Palate by Two-layer Closure (Conservative Management).

    PubMed

    Jain, Harsha; Rao, Dayashankara; Sharma, Shailender; Gupta, Saurabh

    2012-01-01

    Treatment of the cleft palate has evolved over a long period of time. Various techniques of cleft palate repair that are practiced today are the results of principles learned through many years of modifications. The challenge in the art of modern palatoplasty is no longer successful closure of the cleft palate but an optimal speech outcome without compromising maxillofacial growth. Throughout these periods of evolution in the treatment of cleft palate, the effectiveness of various treatment protocols has been challenged by controversies concerning speech and maxillofacial growth. In this article we have evaluated the results of Pinto's modification of Wardill-Kilner palatoplasty without radical dissection of the levator veli palitini muscle on speech and post-op fistula in two different age groups in 20 patients. Preoperative and 6-month postoperative speech assessment values indicated that two-layer palatoplasty (modified Wardill-Kilner V-Y pushback technique) without an intravelar veloplasty technique was good for speech.

  12. EFFECT OF CERTAIN YOGIC ASANAS ON THE PELVIC CONGESTION AND IT'S ANATOMY

    PubMed Central

    Mishra, Satyendra Prasad; Singh, R.H.

    1984-01-01

    20 patient including 6 females and 14 males, between 20 years to 30 years of age, with complaints of chronic constipation refractory to various treatments by medicines, belching, sense of heaviness in the lower abdomen or pelvic region, offensive discharge from vagina (leucorrhoea) and bleeding per rectum with discomfort in the region of perineum were observed under instructions and supervision to practice certain yogic exercises for a period of three years. Viparitakarani, Goraksa asana, Uddyana Bandha and Mula Bandha (Nauli, Perineal Shrug) when practiced, relieved these patients were asked not to take any purgatives or laxatives. It was concluded from the present study that these complaints which can be ascribed to poor hemodynamics in the region of pelvis and perineum disappeared and patients showed obvious improvement after practicing these Asanas which reduced pelvic congestion and increased blood flow to the pelvic viscera i.e rectum, anal canal, prostate, uterus, vagina and levator ani and perineal muscles PMID:22557465

  13. Homology of the jaw muscles in lizards and snakes-a solution from a comparative gnathostome approach.

    PubMed

    Johnston, Peter

    2014-03-01

    Homology or shared evolutionary origin of jaw adductor muscles in lizards and snakes has been difficult to establish, although snakes clearly arose within the lizard radiation. Lizards typically have temporal adductors layered lateral to medial, and in snakes the muscles are arranged in a rostral to caudal pattern. Recent work has suggested that the jaw adductor group in gnathostomes is arranged as a folded sheet; when this theory is applied to snakes, homology with lizard morphology can be seen. This conclusion revisits the work of S.B. McDowell, J Herpetol 1986; 20:353-407, who proposed that homology involves identity of m. levator anguli oris and the loss of m. adductor mandibulae externus profundus, at least in "advanced" (colubroid) snakes. Here I advance the folded sheet hypothesis across the whole snake tree using new and literature data, and provide a solution to this homology problem. Copyright © 2014 Wiley Periodicals, Inc.

  14. The clinical value of magnetic resonance defecography in males with obstructed defecation syndrome.

    PubMed

    Piloni, V; Bergamasco, M; Melara, G; Garavello, P

    2018-03-01

    The aim of the present study was to assess the relationship between symptoms of obstructed defecation and findings on magnetic resonance (MR) defecography in males with obstructed defecation syndrome (ODS). Thirty-six males with ODS who underwent MR defecography at our institution between March 2013 and February 2016 were asked in a telephone interview about their symptoms and subsequent treatment, either medical or surgical. Patients were divided into 2 groups, one with anismus (Group 1) and one with prolapse without anismus (Group 2). The interaction between ODS type and symptoms with MR findings was assessed by multivariate analysis for categorical data using a hierarchical log-linear model. MR imaging findings included lateral and/or posterior rectocele, rectal prolapse, intussusception, ballooning of levator hiatus with impingement of pelvic organs and dyskinetic puborectalis muscle. There were 21 males with ODS due to anismus (Group 1) and 15 with ODS due to rectal prolapse/intussusception (Group 2). Mean age of the entire group was 53.6 ± 4.1 years (range 18-77 years). Patients in Group 1 were slightly older than those in Group 2 (age peak, sixth decade in 47.6 vs 20.0%, p < 0.05). Symptoms most frequently associated with Group 1 patients included small volume and hard feces (85.0%, p < 0.01), excessive strain at stool (81.0%, p < 0.05), tenesmus and fecaloma formation (57.1 and 42.9%, p < 0.05); symptoms most frequently associated with Group 2 patients included mucous discharge, rectal bleeding and pain (86.7%, p < 0.05), prolonged toilet time (73.3%, p < 0.05), fragmented evacuation with or without digitation (66.7%, p < 0.005). Voiding outflow obstruction was more frequent in Group 1 (19.0 vs 13.3%; p < 0.05), while non-bacterial prostatitis and sexual dysfunction prevailed in Group 2 (26.7 and 46.7%, p < 0.05). At MR defecography, two major categories of findings were detected: a dyskinetic pattern (Type 1), seen in all Group 1

  15. Unit Advancement Flap for Lower Lip Reconstruction.

    PubMed

    Ogino, Akihiro; Onishi, Kiyoshi; Okada, Emi; Nakamichi, Miho

    2018-05-01

    Lower lip reconstruction requires consideration of esthetic and functional outcome in selecting a surgical procedure, and reconstruction with local tissue is useful. The authors reconstructed full-thickness defects with a unit advancement flap. Reconstruction was performed using this method in 4 patients with lower lip squamous cell carcinoma in whom tumor resection with preservation of the mouth angle was possible. The lower lip resection width was 30 to 45 mm, accounting for 50% to 68% of the entire width of the lower lip. The flap was prepared by lateral extension from above the mental unit and matched with the potential wrinkle line of the lower lip in order to design a unit morphology surrounded by the anterior margin of the depressor labii inferioris muscle. It was elevated as a full-thickness flap composed of the orbicularis oris muscle, skin, and mucosa of the residual lower lip from the bilateral sides, and advanced to the defect. Flap transfer was adjusted by small triangular resection of the skin on the lateral side of the mental unit. The postoperative scar was inconspicuous in all patients and there was no impairment of the mouth opening-closing or articulation functions. This was a relatively simple surgical procedure. A blood supply of the flap was stable, and continuity of the orbicularis oris muscle was reconstructed by transferred the residual lower lip advancement flap from the bilateral sides. The postoperative mouth opening-closing function was sufficient, and dentures could be placed from an early phase in elderly patients. The postoperative scar was consistent with the lip unit morphology, being esthetically superior. This procedure may be applicable for reconstruction of defects approximately 1/3 to 2/3 the width of the lower lip where the mouth angle is preserved.

  16. P-type voltage-dependent calcium channel mediates presynaptic calcium influx and transmitter release in mammalian synapses.

    PubMed Central

    Uchitel, O D; Protti, D A; Sanchez, V; Cherksey, B D; Sugimori, M; Llinás, R

    1992-01-01

    We have studied the effect of the purified toxin from the funnel-web spider venom (FTX) and its synthetic analog (sFTX) on transmitter release and presynaptic currents at the mouse neuromuscular junction. FTX specifically blocks the omega-conotoxin- and dihydropyridine-insensitive P-type voltage-dependent Ca2+ channel (VDCC) in cerebellar Purkinje cells. Mammalian neuromuscular transmission, which is insensitive to N- or L-type Ca2+ channel blockers, was effectively abolished by FTX and sFTX. These substances blocked the muscle contraction and the neurotransmitter release evoked by nerve stimulation. Moreover, presynaptic Ca2+ currents recorded extracellularly from the interior of the perineural sheaths of nerves innervating the mouse levator auris muscle were specifically blocked by both natural toxin and synthetic analogue. In a parallel set of experiments, K(+)-induced Ca45 uptake by brain synaptosomes was also shown to be blocked or greatly diminished by FTX and sFTX. These results indicate that the predominant VDCC in the motor nerve terminals, and possibly in a significant percentage of brain synapses, is the P-type channel. Images PMID:1348859

  17. P-type voltage-dependent calcium channel mediates presynaptic calcium influx and transmitter release in mammalian synapses.

    PubMed

    Uchitel, O D; Protti, D A; Sanchez, V; Cherksey, B D; Sugimori, M; Llinás, R

    1992-04-15

    We have studied the effect of the purified toxin from the funnel-web spider venom (FTX) and its synthetic analog (sFTX) on transmitter release and presynaptic currents at the mouse neuromuscular junction. FTX specifically blocks the omega-conotoxin- and dihydropyridine-insensitive P-type voltage-dependent Ca2+ channel (VDCC) in cerebellar Purkinje cells. Mammalian neuromuscular transmission, which is insensitive to N- or L-type Ca2+ channel blockers, was effectively abolished by FTX and sFTX. These substances blocked the muscle contraction and the neurotransmitter release evoked by nerve stimulation. Moreover, presynaptic Ca2+ currents recorded extracellularly from the interior of the perineural sheaths of nerves innervating the mouse levator auris muscle were specifically blocked by both natural toxin and synthetic analogue. In a parallel set of experiments, K(+)-induced Ca45 uptake by brain synaptosomes was also shown to be blocked or greatly diminished by FTX and sFTX. These results indicate that the predominant VDCC in the motor nerve terminals, and possibly in a significant percentage of brain synapses, is the P-type channel.

  18. Congenital oculomotor nerve synkinesis associated with fetal retinoid syndrome.

    PubMed

    Morrison, David G; Elsas, Frederick J; Descartes, Maria

    2005-04-01

    Isotretinoin (RA), used for the treatment of cystic acne, is a powerful teratogen, causing craniofacial dysmorphisms and neural tube defects. We present two patients with RA embryopathy and oculomotor nerve synkinesis. Retrospective review of patient records. Two patients presented with third nerve synkinesis and fetal RA exposure. Both had marked elevation of the upper eyelids on adduction such that the lid fissures alternately opened and closed on gaze from side to side. Both patients showed typical dysmorphisms of RA embryopathy. The first patient had complete agenesis of the cerebellar vermix and died at 2 years. The second patient had restricted extraocular muscles in one eye and was exotropic and hypotropic. Both patients demonstrated simultaneous innervation of the medial rectus and levator palpebrae muscles causing coincident lid elevation in adduction. This evidence of oculomotor nerve synkinesis is consistent with animal studies showing abnormalities in the formation of cranial nerve ganglia following fetal RA exposure. RA is a powerful teratogen. These patients provide additional clinical evidence of its influence on neural migration during early development.

  19. Neuromodulation of reciprocal glutamatergic inhibition between antagonistic motoneurons by 5-hydroxytryptamine (5-HT) in crayfish walking system.

    PubMed

    Pearlstein, E; Clarac, F; Cattaert, D

    1998-01-23

    In an in vitro preparation of the crayfish thoracic locomotor system, paired intracellular recordings were performed from antagonistic depressor (Dep) and levator (Lev) motoneurons (MNs) that control the second joint of walking legs. Connections between these two groups of MNs consist mainly of inhibitory connections and weak electrotonic synapses. Injection of depolarizing current into a Lev MN results in a hyperpolarization in a Dep MN, and vice versa. This reciprocal glutamatergic inhibition, is not changed in the presence of the sodium channel blocker tetrodotoxin (TTX) and therefore is likely supported by a direct connection between MNs. By contrast, reciprocal inhibition is largely reduced in the presence of 5-hydroxytryptamine (5-HT; 10 microM). Direct micro-application of glutamate pressure-ejected close to an intracellularly recorded MN, evoked an inhibitory response in that MN, accompanied by a decrease of input resistance. These two effects were dramatically reduced in the presence of 5-HT. Thus 5-HT could be involved in mechanisms of dynamic reconfigurations of the neural network controlling leg movements in crayfish.

  20. Somitic origin of the medial border of the mammalian scapula and its homology to the avian scapula blade

    PubMed Central

    Valasek, Petr; Theis, Susanne; Krejci, Eliska; Grim, Milos; Maina, Flavio; Shwartz, Yulia; Otto, Anthony; Huang, Ruijin; Patel, Ketan

    2010-01-01

    The scapula is the main skeletal element of the pectoral girdle allowing muscular fixation of the forelimb to the axial skeleton. The vertebrate limb skeleton has traditionally been considered to develop from the lateral plate mesoderm, whereas the musculature originates from the axial somites. However, in birds, the scapular blade has been shown to develop from the somites. We investigated whether a somitic contribution was also present in the mammalian scapula. Using genetic lineage-tracing techniques, we show that the medial border of the mammalian scapula develops from somitic cells. The medial scapula border serves as the attachment site of girdle muscles (serratus anterior, rhomboidei and levator scapulae). We show that the development of these muscles is independent of the mechanism that controls the formation of all other limb muscles. We suggest that these muscles be specifically referred to as medial girdle muscles. Our results establish the avian scapular blade and medial border of the mammalian scapula as homologous structures as they share the same developmental origin. PMID:20136669

  1. The interaction between tropomyosin-related kinase B receptors and serine kinases modulates acetylcholine release in adult neuromuscular junctions.

    PubMed

    Santafé, Manel M; Garcia, Neus; Tomàs, Marta; Obis, Teresa; Lanuza, Maria A; Besalduch, Nuria; Tomàs, Josep

    2014-02-21

    We conducted an electrophysiological study of the functional link between the tropomyosin-related kinase B (trkB) receptor signaling mechanism and serine-threonine kinases, both protein kinase C (PKC) and protein kinase A (PKA). We describe their coordinated role in transmitter release at the neuromuscular junction (NMJ) of the Levator auris longus muscle of the adult mouse. The trkB receptor normally seems to be coupled to stimulate ACh release because inhibiting the trkB receptor with K-252a results in a significant reduction in the size of EPPs. We found that the intracellular PKC pathway can operate as in basal conditions (to potentiate ACh release) without the involvement of the trkB receptor function, although the trkB pathway needs an operative PKC pathway if it is to couple to the release mechanism and potentiate it. To actively stimulate PKA (which also results in ACh release potentiation), the operativity of trkB is a necessary condition, and one effect of trkB may be PKA stimulation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Scleral contact lenses for the management of complicated ptosis.

    PubMed

    Katsoulos, Konstantinos; Rallatos, Gerasimos Livir; Mavrikakis, Ioannis

    2018-06-01

    To present the management of three patients suffering from ptosis of various etiologies, with scleral contact lenses. Three patients (five eyes) with ptosis resulting from levator dehiscence due to long-term rigid gas permeable contact lens wear for keratoconus, phthisis bulbi, and myopathy due to Kearns-Sayre syndrome were identified during a 2-year period. They were fitted with scleral contact lenses in order to provide cosmesis by lifting the upper eyelid with the bulk of the lens, and simultaneously provide vision correction where applicable. The scleral contact lenses provided comfortable wear, significantly improved cosmesis as both palpebral aperture and marginal reflex distance were increased, and visual acuity was also subjectively and objectively improved. Two of the patients opted for the scleral contact lenses, whereas the parents of the third patient, a 10-year-old girl with Kearns-Sayre syndrome, chose to undergo ptosis surgery due to handling issues of the scleral contact lenses. Scleral contact lenses can be a useful addition to the treatment option for patients with complicated ptosis.

  3. Pelvic floor morphometry and function in women with and without puborectalis avulsion in the early postpartum period.

    PubMed

    Cyr, Marie-Pierre; Kruger, Jennifer; Wong, Vivien; Dumoulin, Chantale; Girard, Isabelle; Morin, Mélanie

    2017-03-01

    Pelvic floor muscles are subject to considerable stretching during vaginal birth. In 13-36% of women, stretching results in avulsion injury whereby the puborectalis muscle disconnects from its insertion points on the pubis bone. Until now, few studies have investigated the effect of this lesion on pelvic floor muscles in the early postpartum period. The primary aim of this study was to compare pelvic floor muscle morphometry and function in primiparous women with and without puborectalis avulsion in the early postpartum period. Our secondary objective was to compare the 2 groups for pelvic floor disorders and impact on quality of life. In all, 52 primiparous women diagnosed with (n = 22) or without (n = 30) puborectalis avulsion injury were assessed at 3 months postpartum. Pelvic floor muscle morphometry was evaluated with 3-/4-dimensional transperineal ultrasound at rest, maximal contraction, and Valsalva maneuver. Different parameters were measured in the midsagittal and axial planes: bladder neck position, levator plate angle, anorectal angle, and levator hiatus dimensions. The dynamometric speculum was used to assess pelvic floor muscle function including: passive properties (passive forces and stiffness) during dynamic stretches, maximal strength, speed of contraction, and endurance. Pelvic floor disorder-related symptoms (eg, urinary incontinence, vaginal and bowel symptoms) and impact on quality of life were evaluated with the International Consultation on Incontinence Questionnaire and the Pelvic Floor Impact Questionnaire-Short Form. Pelvic Organ Prolapse Quantification was also assessed. In comparison to women without avulsion, women with avulsion presented an enlarged hiatus area at rest, maximal contraction, and Valsalva maneuver (P ≤ .013) and all other ultrasound parameters were found to be significantly altered during maximal contraction (P ≤ .014). They showed lower passive forces at maximal and 20-mm vaginal apertures as well as lower

  4. Androgens enhance in vivo 2-deoxyglucose uptake by rat striated muscle

    NASA Technical Reports Server (NTRS)

    Max, S. R.; Toop, J.

    1983-01-01

    It is shown that testosterone propionate (TP) causes a striking increase in the in vivo uptake of 2-deoxyglucose (2-DG) by the levator ani muscle of immature male rats, which was found to be uniformly distributed over the entire muscle. After a single subcutaneous injection of TP, no enhancement of 2-DG was observed before 3.5 hr, at which time uptake was increased 2-fold; maximum enhancement (4-fold) was attained at 12 hr. At 72 hr, 2-DG uptake remained elevated at twice the control value. It was determined that the effect of TP probably is mediated by specific androgen receptors. In addition, it was found that the effect of TP was blocked by the simultaneous administration of an androgen antagonist, cyproterone acetate. TP also was found to enhance the uptake of 2-DG in the bulbocavernosus (253 percent over control) and extensor digitorum longus muscles (150 percent over control), but not in the biceps brachii or soleus. It is suggested that the increased uptake of glucose may be an important early step in the anabolic response of muscle to androgens.

  5. The sperm pump of the hangingfly Bittacus planus Cheng (Mecoptera: Bittacidae).

    PubMed

    Gao, Qiong-Hua; Hua, Bao-Zhen

    2015-11-01

    The males of antliophoran insects usually use a sperm pump to transfer liquid sperm into the reproductive tract of the female. However, the fine structure of the sperm pump and its ejaculatory mechanism has not been thoroughly clarified in many groups of Mecoptera. In this paper, the structure of the sperm pump was investigated in the hangingfly Bittacus planus Cheng, 1949 using light and scanning electron microscopy. The sperm pump mainly consists of a piston fused with a piston-carrying sclerite, a pumping chamber enclosed by the genital folds, which comprises the posterior region of the ejaculatory sac, an ostial sclerite, a phallobase, and other associated structures and muscles. The piston crown plays a major role in the piston movement. The ostial sclerite serves as a discharge valve and is controlled by two antagonistic muscles. No depressor muscles were found attached to the piston. The sperm pumping activity is mainly controlled by the combination of the levator of the piston and the retractor and protractor of the ostial sclerite. The ejaculatory mechanism and phylogenetic significance are briefly discussed based on the structure of the sperm pump. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Anatomy of the lateral ligaments of the rectum: a controversial point of view.

    PubMed

    Wang, Guo-Jun; Gao, Chun-Fang; Wei, Dong; Wang, Cun; Meng, Wen-Jian

    2010-11-21

    The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by "hooking them on the finger" has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes.

  7. Anatomy of the lateral ligaments of the rectum: A controversial point of view

    PubMed Central

    Wang, Guo-Jun; Gao, Chun-Fang; Wei, Dong; Wang, Cun; Meng, Wen-Jian

    2010-01-01

    The existence and composition of the lateral ligaments of the rectum (LLR) are still the subjects of anatomical confusion and surgical misconception up to now. Since Miles proposed abdominoperineal excision as radical surgery for rectal cancer, the identification by “hooking them on the finger” has been accepted by many surgeons with no doubt; clamping, dividing and ligating are considered to be essential procedures in mobilization of the rectum in many surgical textbooks. But in cadaveric studies, many anatomists could not find LLR described by the textbooks, and more and more surgeons also failed to find LLR during the proctectomy according to the principle of total mesorectal excision. The anatomy of LLR has diverse descriptions in literatures. According to our clinical observations, the traditional anatomical structures of LLR do exist; LLR are constant dense connective bundles which are located in either lateral side of the lower part of the rectum, run between rectal visceral fascia and pelvic parietal fascia above the levator ani, and covered by superior fascia of pelvic diaphragm. They are pathways of blood vessels and nerve fibers toward the rectum and lymphatic vessels from the lower rectum toward the iliac lymph nodes. PMID:21086557

  8. [Therapy-resistant swelling of the upper eyelid in childhood].

    PubMed

    Haustein, M; Terai, N; Pablik, J; Pillunat, L E; Sommer, F

    2014-01-01

    Swelling of the upper eyelid in childhood is caused by a variety of diseases and is very often generated by inflammation but orbital tumors should always be considered in the differential diagnostics. We report about a 4-year-old girl with a drug-resistant swelling of the upper eyelid and ptosis of the right eye. This case report demonstrates the route from initial clinical examination to diagnosis and additionally reviews the current status of therapeutic options. After magnetic resonance imaging (MRI) and diagnostic excision, Langerhans cell histiocytosis (LCH) could be histologically proven. Visual acuity and levator muscle function improved from 0.5 to 1.25 and from 2 mm to 12 mm, respectively, by amblyopic prophylaxis and immunosuppressive therapy. Persistent and drug-resistant swelling of the upper eyelid in childhood is also strongly suspicious for tumors. The suspicion of rare orbital tumors in children can be frequently substantiated by MRI. Biopsy and histological diagnosis are essential to plan adequate treatment and to estimate the prognosis. Particularly in Langerhans cell histiocytosis the methods of choice for over 10 years are specific immunochemical procedures (detection of protein s100 and CD1a).

  9. Endoanal MRI of the anal sphincter complex: correlation with cross-sectional anatomy and histology.

    PubMed Central

    Hussain, S M; Stoker, J; Zwamborn, A W; Den Hollander, J C; Kuiper, J W; Entius, C A; Laméris, J S

    1996-01-01

    The purpose of this study was to correlate the in vivo endoanal MRI findings of the anal sphincter with the cross-sectional anatomy and histology. Fourteen patients with rectal tumours were examined with a rigid endoanal MR coil before undergoing abdominoperineal resection. In addition, 12 cadavers were used to obtain cross-sectional anatomical sections. The images were correlated with the histology and anatomy of the resected rectal specimens as well as with the cross-sectional anatomical sections of the 12 cadavers. The findings in 8 patients, 11 rectal preparations, and 10 cadavers, could be compared. In these cases, there was an excellent correlation between endoanal MRI and the cross-sectional cadaver anatomy and histology. With endoanal MRI, all muscle layers of the anal canal wall, comprising the internal anal sphincter, longitudinal muscle, the external anal sphincter and the puborectalis muscle were clearly visible. The levator ani muscle and ligamentous attachments were also well demonstrated. The perianal anatomical spaces, containing multiple septae, were clearly visible. In conclusion, endoanal MRI is excellent for visualising the anal sphincter complex and the findings show a good correlation with the cross-sectional anatomy and histology. Images Fig. 1 Fig. 2 PMID:8982844

  10. Chronic proctalgia and chronic pelvic pain syndromes: New etiologic insights and treatment options

    PubMed Central

    Chiarioni, Giuseppe; Asteria, Corrado; Whitehead, William E

    2011-01-01

    This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs: chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence available to guide their diagnosis and treatment. This situation appears to be changing: A recently published large randomized, controlled trial by our group comparing biofeedback, electrogalvanic stimulation, and massage for the treatment of chronic proctalgia has shown success rates of 85% for biofeedback when patients are selected based on physical examination evidence of tenderness in response to traction on the levator ani muscle-a physical sign suggestive of striated muscle tension. Excessive tension (spasm) in the striated muscles of the pelvic floor appears to be common to most of the pelvic pain syndromes. This suggests the possibility that similar approaches to diagnostic assessment and treatment may improve outcomes in other pelvic pain disorders. PMID:22110274

  11. Exogenous ciliary neurotrophic factor (CNTF) reduces synaptic depression during repetitive stimulation.

    PubMed

    Garcia, Neus; Santafé, Manel M; Tomàs, Marta; Priego, Mercedes; Obis, Teresa; Lanuza, Maria A; Besalduch, Nuria; Tomàs, Josep

    2012-09-01

    It has been shown that ciliary neurotrophic factor (CNTF) has trophic and maintenance effects on several types of peripheral and central neurons, glia, and cells outside the nervous system. Both CNTF and its receptor, CNTF-Rα, are expressed in the muscle. We use confocal immunocytochemistry to show that the trophic cytokine and its receptor are present in the pre- and post-synaptic sites of the neuromuscular junctions (NMJs). Applied CNTF (7.5-200 ng/ml, 60 min-3 h) does not acutely affect spontaneous potentials (size or frequency) or quantal content of the evoked acetylcholine release from post-natal (in weak or strong axonal inputs on dually innervated end plates or in the most mature singly innervated synapses at P6) or adult (P30) NMJ of Levator auris longus muscle of the mice. However, CNTF reduces roughly 50% the depression produced by repetitive stimulation (40 Hz, 2 min) on the adult NMJs. Our findings indicate that, unlike neurotrophins, exogenous CNTF does not acutely modulate transmitter release locally at the mammalian neuromuscular synapse but can protect mature end plates from activity-induced synaptic depression. © 2012 Peripheral Nerve Society.

  12. Vaginal biological and sexual health--the unmet needs.

    PubMed

    Graziottin, A

    2015-01-01

    The vagina is a most neglected organ. It is usually clinically considered with a minimalistic view, as a 'connecting tube' for a number of physiologic functions: passage of menstrual blood, intercourse, natural conception and delivery. Unmet needs include, but are not limited to, respect of vaginal physiologic biofilms; diagnosis and care of the optimal tone of the levator ani, which surrounds and partly support it; care of its anatomic integrity at and after delivery and at pelvic/vaginal surgery; care of long-term consequences of pelvic radiotherapy; long-term care of the atrophic changes it will undergo after the menopause, unless appropriate, at least local, estrogen therapy is used; appreciation and respect of its erotic meaning, as a loving, receptive, 'bonding' organ for the couple. The vaginal erotic value is key as a non-visible powerful center of femininity and sexuality, deeply and secretly attractive in terms of taste, scent (together with the vulva), touch and proprioception. The most welcoming when lubrication, softness and vaginal orgasm award the woman and the partner with the best of pleasures. Prevention of sexual/vaginal abuse is a very neglected unmet need, as well. Who cares?

  13. Steroidal androgens and nonsteroidal, tissue-selective androgen receptor modulator, S-22, regulate androgen receptor function through distinct genomic and nongenomic signaling pathways.

    PubMed

    Narayanan, Ramesh; Coss, Christopher C; Yepuru, Muralimohan; Kearbey, Jeffrey D; Miller, Duane D; Dalton, James T

    2008-11-01

    Androgen receptor (AR) ligands are important for the development and function of several tissues and organs. However, the poor oral bioavailability, pharmacokinetic properties, and receptor cross-reactivity of testosterone, coupled with side effects, place limits on its clinical use. Selective AR modulators (SARMs) elicit anabolic effects in muscle and bone, sparing reproductive organs like the prostate. However, molecular mechanisms underlying the tissue selectivity remain ambiguous. We performed a variety of in vitro studies to compare and define the molecular mechanisms of an aryl propionamide SARM, S-22, as compared with dihydrotestosterone (DHT). Studies indicated that S-22 increased levator ani muscle weight but decreased the size of prostate in rats. Analysis of the upstream intracellular signaling events indicated that S-22 and DHT mediated their actions through distinct pathways. Modulation of these pathways altered the recruitment of AR and its cofactors to the PSA enhancer in a ligand-dependent fashion. In addition, S-22 induced Xenopus laevis oocyte maturation and rapid phosphorylation of several kinases, through pathways distinct from steroids. These studies reveal novel differences in the molecular mechanisms by which S-22, a nonsteroidal SARM, and DHT mediate their pharmacological effects.

  14. Surgical Correction of Hallermann-Streiff Syndrome: A Case Report of Esotropia, Entropion, and Blepharoptosis

    PubMed Central

    Cho, Won-Kyung; Park, Joo Wan

    2011-01-01

    We report a case of surgical treatment for Hallermann-Streiff syndrome in a patient with ocular manifestations of esotropia, entropion, and blepharoptosis. A 54-year-old man visited Yeouido St. Mary's Hospital complaining of ocular discomfort due to cilia touching the corneas of both eyes for several years. He had a bird-like face, pinched nose, hypotrichosis of the scalp, mandibular hypoplasia with forward displacement of the temporomandibular joints, a small mouth, and proportional short stature. His ophthalmic features included sparse eyelashes and eyebrows, microphthalmia, nystagmus, lower lid entropion in the right eye, and upper lid entropion with blepharoptosis in both eyes. There was esodeviation of the eyeball of more than 100 prism diopters at near and distance, and there were limitations in ocular movement on lateral gaze. The capsulopalpebral fascia was repaired to treat the right lower lid entropion, but an additional Quickert suture was required to prevent recurrence. Blepharoplasty and levator palpebrae repair were performed for blepharoptosis and dermatochalasis. Three months after lid surgery, the right medial rectus muscle was recessed 7.5 mm, the left medial rectus was recessed 7.25 mm, and the left lateral rectus muscle was resected 8.0 mm. PMID:21461230

  15. [Sacrospinous colpopexy complications].

    PubMed

    Estrade, J-P; Agostini, A; Roger, V; Dallay, D; Blanc, B; Cravello, L

    2004-10-01

    To evaluate complications of sacrospinous ligament fixation. Monocentric retrospective study. Department of Obstetrics & Gynecology, La Conception University Hospital, Marcella. Between January 1991 and September 2002, 277 women (mean age 64.9 years, range 37 to 92 years) underwent a sacrospinous ligament fixation; 91% had a menopausal status, and 15.5% used hormone replacement therapy. 33.2% of the patients had prior hysterectomy, 28.9% had a history of surgery for prolapse, and 18.8% had associated symptoms of stress urinary incontinence. In all cases, sacrospinous ligament fixation was performed under visual control using conventional stitch. Sacrospinous ligament fixation was combined with the following procedures: anterior vaginal repair (N =137), additional incontinence surgery (N =31), vaginal hysterectomy (N =137), levator myorraphy (N =203). Intraoperative complications, postoperative complications, long-term painful symptoms. Intraoperative complications were represented by 1 case of vascular wound and four rectal injuries. Main postoperative complications were vaginal haematomas (N =6) and abscesses (N =2). Long-term symptoms were perineal pain, sciatic neuralgia, and dyspareunia. There was no surgical mortality, and we noted low rates of major complications. Sacrospinous ligament fixation assumes high priority in our therapeutic regimen.

  16. Fiber-type distribution in insect leg muscles parallels similarities and differences in the functional role of insect walking legs.

    PubMed

    Godlewska-Hammel, Elzbieta; Büschges, Ansgar; Gruhn, Matthias

    2017-10-01

    Previous studies have demonstrated that myofibrillar ATPase (mATPase) enzyme activity in muscle fibers determines their contraction properties. We analyzed mATPase activities in muscles of the front, middle and hind legs of the orthopteran stick insect (Carausius morosus) to test the hypothesis that differences in muscle fiber types and distributions reflected differences in their behavioral functions. Our data show that all muscles are composed of at least three fiber types, fast, intermediate and slow, and demonstrate that: (1) in the femoral muscles (extensor and flexor tibiae) of all legs, the number of fast fibers decreases from proximal to distal, with a concomitant increase in the number of slow fibers. (2) The swing phase muscles protractor coxae and levator trochanteris, have smaller percentages of slow fibers compared to the antagonist stance muscles retractor coxae and depressor trochanteris. (3) The percentage of slow fibers in the retractor coxae and depressor trochanteris increases significantly from front to hind legs. These results suggest that fiber-type distribution in leg muscles of insects is not identical across leg muscles but tuned towards the specific function of a given muscle in the locomotor system.

  17. Special Issue "Natural Hazards' Impact on Urban Areas and Infrastructure" in Natural Hazards

    NASA Astrophysics Data System (ADS)

    Bostenaru Dan, M.

    2009-04-01

    In 2006 and 2007, at the 3rd and 4th General Assembly of the European Geosciences Union respectivelly, the session on "Natural Hazards' Impact on Urban Areas and Infrastructure" was convened by Maria Bostenaru Dan, then at the Istituto Universitario di Studi Superiori di Pavia, ROSE School, Italy, who conducts research on earthquake management and Heidi Kreibich from the GFZ Potsdam, Germany, who conducts research on flood hazards, in 2007 being co-convened also by Agostino Goretti from the Civil Protection in Rome, Italy. The session initially started from an idea of Friedemann Wenzel from the Universität Karlsruhe (TH), Germany, the former speaker of the SFB 461 "Strong earthquakes", the university where also Maria Bostenaru graduated and worked and which runs together with the GFZ Potsdam the CEDIM, the Center for Disaster Management and Risk Reduction Technology. Selected papers from these two sessions as well as invited papers from other specialists were gathered for a special issue to be published in the journal "Natural Hazards" under the guest editorship of Heidi Kreibich and Maria Bostenaru Dan. Unlike the former special issue, this one contains a well balanced mixture of many hazards: climate change, floods, mountain hazards like avalanches, volcanoes, earthquakes. Aim of the issue was to enlarge the co-operation prospects between geosciences and other professions in field of natural hazards. Earthquake engineering and engineering seismology are seen more frequently co-operating, but in field of natural hazards there is a need to co-operate with urban planners, and, looking to the future, also in the field of integrated conservation, which implies co-operation between architecture and urban planning for the preservation of our environment. Integrated conservation is stipulated since the 1970s, which are the years when the participatism, and so the involvment of social sciences started.

  18. Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial.

    PubMed

    Student, Vladimir; Vidlar, Ales; Grepl, Michal; Hartmann, Igor; Buresova, Eva; Student, Vladimir

    2017-05-01

    The advent of robotics has facilitated new surgical techniques for radical prostatectomy. These allow adjustment of pelvic anatomical and functional relationships after removal of the prostate to ameliorate postprostatectomy incontinence (PPI) and reduce the time to complete continence. To describe the results of a new surgical technique for reconstruction of vesicourethral anastomosis using the levator ani muscle for support during robot-assisted radical prostatectomy (RARP). A prospective, randomised, single-blind study among 66 consecutive patients with localised prostate cancer (cT1-2N0M0) undergoing RARP from June to September 2014, 32 using the new technique and 34 using the standard posterior reconstruction according to Rocco. In the advanced reconstruction of vesicourethral support (ARVUS) intervention group, the fibres of the levator ani muscle, Denonvilliers fascia, retrotrigonal layer, and median dorsal raphe were used to form the dorsal support for the urethrovesical anastomosis. Suture of the arcus tendineus to the bladder neck served as the anterior fixation. We compared demographic data and preoperative and postoperative functional and oncologic results for the two groups. The primary endpoint was continence evaluated at different time points (24h, 2, 4, and 8 wk, and 6 and 12 mo). The secondary endpoints were perioperative and postoperative complications and erectile function. Using a continence definition of 0 pads/d, the continence rates for the ARVUS versus the control group were 21.9% versus 5.9% at 24h (p=0.079), 43.8% versus 11.8% at 2 wk (p=0.005), 62.5% versus 14.7% at 4 wk (p<0.001), 68.8% versus 20.6% at 8 wk (p<0.001), 75.0% versus 44.1% at 6 mo (p=0.013), and 86.66% versus 61.29% at 12 mo (p=0.04). International Index of Erectile Function questionnaire results at 6 and 12 mo after surgery showed similar potency rates for the control group (40.0% and 73.33%) and the ARVUS group (38.8% and 72.22%). There were four postoperative

  19. Some endocrinological aspects of barbiturate dependence.

    PubMed

    Norton, P R

    1971-02-01

    1. Hypophysectomized rats become dependent on barbitone and show the same withdrawal syndrome as intact animals.2. Barbitone dependent rats have larger thyroid and adrenal glands, a larger liver, smaller gonads and larger secondary sex organs than untreated animals. The levator ani muscle of the males is smaller.3. In contrast, dependent female hypophysectomized rats only showed a decreased gonad weight and increased liver weight.4. Histologically, the thyroid gland of dependent rats appears more active, but the concentration of iodine bound to plasma protein, basal metabolic rate and body temperature are similar in dependent and untreated animals.5. Resting plasma corticosterone concentration appears to be unchanged in barbitone dependent animals, but stress induced increases in the concentration of corticosterone in plasma are less in dependent animals.6. Immature barbitone dependent rats grow at a faster rate than untreated animals, but hypophysectomized rats of similar age receiving barbitone do not.7. The additional body weight gained by barbitone dependent animals is of normal body composition.8. Administration of growth hormone has an identical growth inducing effect in dependent hypophysectomized animals and in untreated hypophysectomized animals.9. Barbitone dependent rats do not exhibit the ;frustration effect' in a double runway. In barbitone dependent rats approach to a potentially ;frustrating' situation is slower than in untreated animals.

  20. Examining a New Method to Studying Velopharyngeal Structures in a Child With 22q11.2 Deletion Syndrome.

    PubMed

    Kollara, Lakshmi; Schenck, Graham; Jaskolka, Michael; Perry, Jamie L

    2017-04-14

    To date, no studies have imaged the velopharynx in children with 22q11.2 deletion syndrome (22q11.2 DS) without the use of sedation. Dysmorphology in velopharyngeal structures has been shown to have significant negative implications on speech among these individuals. This single case study was designed to assess the feasibility of a child-friendly magnetic resonance imaging (MRI) scanning protocol in this clinically challenging population and to determine the utility of this MRI protocol for future work in this area. One 6-year-old White girl diagnosed with 22q11.2 DS was imaged using a child-friendly, nonsedated MRI protocol. Quantitative and qualitative measures of the velopharyngeal area and associated structures were evaluated, and comparisons were made to age-matched control subjects with normal velopharyngeal anatomy. MRI data were successfully obtained using the child-friendly scanning protocol in the subject in the present study. Quantitative and qualitative differences of the levator muscle and associated velopharyngeal structures were noted. Using these MRI and structural analyses methods, insights related to muscle morphology can be obtained and considered as part of the research and clinical examination of children with 22q11.2 DS. The imaging protocol described in this study presents an effective means to counteract difficulties in imaging young children.

  1. [Primary diffuse large B-cell lymphoma of the uterine cervix--a case report].

    PubMed

    Okudaira, Taeko; Nagasaki, Akitoshi; Miyagi, Takashi; Nakazato, Tetsuro; Taira, Naoya; Kudaka, Wataru; Maehama, Toshiyuki; Takasu, Nobuyuki

    2008-08-01

    Primary malignant lymphoma of the female genital tract is an extremely rare clinical entity. We report a case of primary non-Hodgkin lymphoma of the uterine cervix. A 68-year-old woman presented with abnormal genital bleeding in May 2002. A coloposcopic examination revealed a mass in the uterine cervix. Magnetic resonance imaging showed a bulky cervical tumor(7.5 x 8 cm)invading the right parametrium and adjacent levator ani muscle. Involvement of pelvic lymph nodes was also observed. The uterine lesion exhibited homogenous hypointensity on T1 weight image and isointense to hyperintense on T2-weight image. No other lesions were detected by the whole-body computed tomography, gallium scintigraphy, and bone marrow examination. Although cytology of the smear from the uterine cervix was nondiagnostic, the histologic examination of the punch biopsy material showed a diffuse proliferation of atypical lymphoid cells. Immunophenotypic studies revealed tumor cells were positive for CD19, CD20, CD30, and k-chain. A diagnosis of diffuse large B-cell lymphoma of the uterine cervix, clinical stage IIE was made. The patient was treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone(CHOP)chemotherapy followed by the involved field irradiation. She remains alive and free of disease more than 5 years after the diagnosis.

  2. [Anatomical names of fossae and foveae in skeleton].

    PubMed

    Shikano, S; Yamashita, Y

    1999-09-01

    Latin anatomical names of Fossae and Foveae in the skeleton were analyzed and compared with Japanese anatomical names for better understanding of the structures of the human body and for possible revision in the future. The conclusions were as follows: 1. In general, round excavations were called Foveae (singular : Fovea), and nonround excavations were called Fossae (singular : Fossa). Some shallow excavations for articulation and some shallow excavations with the names which indicate their contents were called Foveae even though they were not round. 2. Each name of Fossae contained the word which indicates form, location or content of Fossa, the bone (or osseous structure) which articulates with Fossa, or the muscle which is attached to Fossa. 3. Each name of Foveae contained the word which indicates location, content or articulation of Fovea, the bone (or osseous structure) which articulates with Fovea, or the muscle (or muscular trochlea) which is attached to Fovea. 4. The Japanese name which corresponds to Fossa canina should be changed from Kenshi (canine tooth) = ka (fossa) to Kenshikin (canine muscle) = ka or Koukakukyokin (levator anguli oris muscle) = ka. 5. The Japanese name which corresponds to Fossa pterygopalatina should be changed from Yoku (wing) = kougai (palate) = ka (fossa) to Yokutotsu (pterygoid process) = kougaikotsu (palatine bone) = ka.

  3. A Review of the Surgical Management of Perineal Hernias in Dogs.

    PubMed

    Gill, Sukhjit Singh; Barstad, Robert D

    2018-05-14

    Perineal hernia refers to the failure of the muscular pelvic diaphragm to support the rectal wall, resulting in herniation of pelvic and, occasionally, abdominal viscera into the subcutaneous perineal region. The proposed causes of pelvic diaphragm weakness include tenesmus associated with chronic prostatic disease or constipation, myopathy, rectal abnormalities, and gonadal hormonal imbalances. The most common presentation of perineal hernia in dogs is a unilateral or bilateral nonpainful swelling of the perineum. Clinical signs do occur, but not always. Clinical signs may include constipation, obstipation, dyschezia, tenesmus, rectal prolapse, stranguria, or anuria. The definitive diagnosis of perineal hernia is based on clinical signs and findings of weak pelvic diaphragm musculature during a digital rectal examination. In dogs, perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes difficult to perform as the levator ani and coccygeus muscles are atrophied and unsuitable for use. Internal obturator muscle transposition is the most commonly used technique. Additional techniques include superficial gluteal and semitendinosus muscle transposition, in addition to the use of synthetic implants and biomaterials. Pexy techniques may be used to prevent rectal prolapse and bladder and prostate gland displacement. Postoperative care involves analgesics, antibiotics, a low-residue diet, and stool softeners.

  4. A Computational Model Quantifies the Effect of Anatomical Variability on Velopharyngeal Function

    PubMed Central

    Inouye, Joshua M.; Perry, Jamie L.; Lin, Kant Y.

    2015-01-01

    Purpose This study predicted the effects of velopharyngeal (VP) anatomical parameters on VP function to provide a greater understanding of speech mechanics and aid in the treatment of speech disorders. Method We created a computational model of the VP mechanism using dimensions obtained from magnetic resonance imaging measurements of 10 healthy adults. The model components included the levator veli palatini (LVP), the velum, and the posterior pharyngeal wall, and the simulations were based on material parameters from the literature. The outcome metrics were the VP closure force and LVP muscle activation required to achieve VP closure. Results Our average model compared favorably with experimental data from the literature. Simulations of 1,000 random anatomies reflected the large variability in closure forces observed experimentally. VP distance had the greatest effect on both outcome metrics when considering the observed anatomic variability. Other anatomical parameters were ranked by their predicted influences on the outcome metrics. Conclusions Our results support the implication that interventions for VP dysfunction that decrease anterior to posterior VP portal distance, increase velar length, and/or increase LVP cross-sectional area may be very effective. Future modeling studies will help to further our understanding of speech mechanics and optimize treatment of speech disorders. PMID:26049120

  5. Predictive role of measurement of pelvic floor muscle thickness with static MRI in stress and mixed urinary incontinence.

    PubMed

    Yaşar, Levent; Telci, Serpil Ortakuz; Doğan, Keziban; Kaya, Eyüp; Ekin, Murat

    2018-05-19

    To investigate the role of measuring the thickness of pelvic floor muscles with static MRI in the physiopathology of urinary incontinence in women with stress and mixed types of urinary incontinence diagnosed with urodynamic studies. A retrospective clinical study was designed in collaboration with the radiology department. We recruited only patients who had undergone static pelvic MRI to determine the etiology of pelvic pain and exclude gynecologic disorders. The study included 45 women diagnosed with stress or mixed-type urinary incontinence based on pelvic examination and urodynamic testing without symptomatic pelvic organ prolapse and 40 continent controls. We evaluated the images of pelvic static MRI of all patients to measure the thickness of the pelvic floor muscles with the radiologist by using an image analysis workstation retrospectively. The right and left puborectalis parts of levator ani muscle thicknesses were significantly lower in the urinary incontinence group than in the control group (p < 0.01). The right and left PR/OI ratios were significantly lower than in the control group. (p = 0.001). Morphologic changes of pelvic floor muscle thickness can be demonstrated by a static pelvic MRI, and this can be used as a prognostic test in the treatment and follow-up of patients with stress or mixed urinary incontinence.

  6. Pelvic floor muscle lesions at endoanal MR imaging in female patients with faecal incontinence.

    PubMed

    Terra, Maaike P; Beets-Tan, Regina G H; Vervoorn, Inge; Deutekom, Marije; Wasser, Martin N J M; Witkamp, Theo D; Dobben, Annette C; Baeten, Cor G M I; Bossuyt, Patrick M M; Stoker, Jaap

    2008-09-01

    To evaluate the frequency and spectrum of lesions of different pelvic floor muscles at endoanal MRI in women with severe faecal incontinence and to study their relation with incontinence severity and manometric findings. In 105 women MRI examinations were evaluated for internal anal sphincter (IAS), external anal sphincter (EAS), puborectal muscle (PM) and levator ani (LA) lesions. The relative contribution of lesions to differences in incontinence severity and manometric findings was studied. IAS (n = 59) and EAS (n = 61) defects were more common than PM (n = 23) and LA (n = 26) defects. PM and LA defects presented mainly with IAS and/or EAS defects (isolated n = 2 and n = 3). EAS atrophy (n = 73) was more common than IAS (n = 19), PM (n = 16) and LA (n = 9) atrophy and presented mainly isolated. PM and LA atrophy presented primarily with EAS atrophy (isolated n = 3 and n = 1). Patients with IAS and EAS lesions had a lower resting and squeeze pressure, respectively; no other associations were found. PM and LA lesions are relatively common in patients with severe faecal incontinence, but the majority of lesions are found in women who also have IAS and/or EAS lesions. Only an association between anal sphincter lesions and manometry was observed.

  7. Distribution of thyroid hormone and thyrotropin receptors in reproductive tissues of adult female rabbits.

    PubMed

    Rodríguez-Castelán, Julia; Anaya-Hernández, Arely; Méndez-Tepepa, Maribel; Martínez-Gómez, Margarita; Castelán, Francisco; Cuevas-Romero, Estela

    2017-02-01

    Thyroid dysfunctions are related to anovulation, miscarriages, and infertility in women and laboratory animals. Mechanisms associated with these effects are unknown, although indirect or direct actions of thyroid hormones and thyrotropin could be assumed. The present study aimed to identify the distribution of thyroid hormones (TRs) and thyrotropin (TSHR) receptors in reproductive organs of female rabbits. Ovary of virgin and pregnant rabbits, as well as the oviduct, uterus, and vagina of virgin rabbits were excised, histologically processed, and cut. Slices from these organs were used for immunohistochemical studies for TRα1-2, TRß1, and TSHR. The presence of TRs and TSHR was found in the primordial, primary, secondary, tertiary, and Graafian follicles of virgin rabbits, as well as in the corpora lutea, corpora albicans, and wall of hemorrhagic cysts of pregnant rabbits. Oviductal regions (fimbria-infundibulum, ampulla, isthmus, and utero-tubal junction), uterus (endometrium and myometrium), and vagina (abdominal, pelvic, and perineal portions) of virgin rabbits showed anti-TRs and anti-TSHR immunoreactivity. Additionally, the distal urethra, paravaginal ganglia, levator ani and iliococcygeus muscles, dorsal nerve and body of the clitoris, perigenital skin, and prostate had TRs and TSHR. The wide presence of TRs and TSHR in female reproductive organs suggests varied effects of thyroid hormones and thyrotropin in reproduction.

  8. Magnetic Resonance Imaging of the anal canal using high resolution sequences and phased array coil: visualization of anal sphincter complex.

    PubMed

    Laghi, A; Iafrate, F; Paolantonio, P; Iannaccone, R; Baeli, I; Ferrari, R; Catalano, C; Passariello, R

    2002-04-01

    To assess the normal anatomy of the anal sphincter complex using high-resolution MR imaging with phased -array coil. Twenty patients, 13 males and 7 females, ranging in age between 27 and 56 years underwent MRI evaluation of the pelvic region, using a superconductive 1.5 T magnet (maximum gradient strength, 25 mT/m; minimum rise time 600 microseconds, equipped with phased-array coil. High-resolution T2-weighted Turbo Spin Echo sequences (TR, 4055 ms; TE, 132 ms; matrix 390x512; in-plane resolution, 0.67x0.57 mm) were acquired on multiple axial, sagittal and coronal planes. Images were reviewed by two experienced gastrointestinal radiologists in order to evaluate the normal anal sphincter complex. Optimal image quality of the anal sphincter complex was obtained in all cases. Different muscular layers were observed between the upper and lower aspects of the anal canal. In the lower part of the anal canal, internal and external sphincter muscles could be observed; in the upper part, puborectal and internal sphincter muscles were depicted. Good visualization of intersphincteric space, levator ani muscle and ischioanal space was also obtained in all cases. High-resolution MR images with phased-array coil provide optimal depiction of the anal canal and the anal sphincter complex.

  9. Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions.

    PubMed

    Bhattarai, Aroj; Staat, Manfred

    2018-01-01

    After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females.

  10. Modelling of Soft Connective Tissues to Investigate Female Pelvic Floor Dysfunctions

    PubMed Central

    2018-01-01

    After menopause, decreased levels of estrogen and progesterone remodel the collagen of the soft tissues thereby reducing their stiffness. Stress urinary incontinence is associated with involuntary urine leakage due to pathological movement of the pelvic organs resulting from lax suspension system, fasciae, and ligaments. This study compares the changes in the orientation and position of the female pelvic organs due to weakened fasciae, ligaments, and their combined laxity. A mixture theory weighted by respective volume fraction of elastin-collagen fibre compound (5%), adipose tissue (85%), and smooth muscle (5%) is adopted to characterize the mechanical behaviour of the fascia. The load carrying response (other than the functional response to the pelvic organs) of each fascia component, pelvic organs, muscles, and ligaments are assumed to be isotropic, hyperelastic, and incompressible. Finite element simulations are conducted during Valsalva manoeuvre with weakened tissues modelled by reduced tissue stiffness. A significant dislocation of the urethrovesical junction is observed due to weakness of the fascia (13.89 mm) compared to the ligaments (5.47 mm). The dynamics of the pelvic floor observed in this study during Valsalva manoeuvre is associated with urethral-bladder hypermobility, greater levator plate angulation, and positive Q-tip test which are observed in incontinent females. PMID:29568322

  11. Giulio Cesare Aranzio (Arantius) (1530-89) in the pageant of anatomy and surgery.

    PubMed

    Gurunluoglu, Raffi; Shafighi, Maziar; Gurunluoglu, Aslin; Cavdar, Safiye

    2011-05-01

    Giulio Cesare Aranzio in Italian (Julius Caesar Arantius in Latin) has not received full acclaim for his achievements in the field of anatomy and surgery that remain unknown to most physicians. His anatomical books Observationes Anatomicas, and De Humano Foetu Opusculum and surgical books De Tumoribus Secundum Locos Affectos and Hippocratis librum de vulneribus capitis commentarius brevis printed in Latin and additional existing literature on Aranzio from medical history books and journals were analysed extensively. Aranzio became Professor of Anatomy and Surgery at the University of Bologna in 1556. He established anatomy as a distinguished branch of medicine for the first time in medical history. Aranzio combined anatomy with a description of pathological processes. He discovered the 'Nodules of Aranzio' in the semilunar valves of the heart. He gave the first description of the superior levator palpebral and the coracobrachialis muscles. Aranzio wrote on surgical techniques for a wide spectrum of conditions that range from hydrocephalus, nasal polyp, goitre and tumours to phimosis, ascites, haemorrhoids, anal abscess and fistulae, and much more. Aranzio had an extensive knowledge in surgery and anatomy based in part on the ancient Greek and his contemporaries in the 16th century but essentially on his personal experience and practice.

  12. Functional Anorectal Disorders.

    PubMed

    Rao, Satish Sc; Bharucha, Adil E; Chiarioni, Giuseppe; Felt-Bersma, Richelle; Knowles, Charles; Malcolm, Allison; Wald, Arnold

    2016-03-25

    This report defines criteria and reviews the epidemiology, pathophysiology, and management of common anorectal disorders: fecal incontinence (FI), functional anorectal pain and functional defecation disorders. FI is defined as the recurrent uncontrolled passage of fecal material for at least 3 months. The clinical features of FI are useful for guiding diagnostic testing and therapy. Anorectal manometry and imaging are useful for evaluating anal and pelvic floor structure and function. Education, antidiarrheals and biofeedback therapy are the mainstay of management; surgery may be useful in refractory cases. Functional anorectal pain syndromes are defined by clinical features and categorized into three subtypes. In proctalgia fugax, the pain is typically fleeting and lasts for seconds to minutes. In levator ani syndrome (LAS) and unspecified anorectal pain the pain lasts more than 30 minutes, but in LAS there is puborectalis tenderness. Functional defecation disorders are defined by >2 symptoms of chronic constipation or irritable bowel syndrome with constipation, and with >2 features of impaired evacuation i.e., abnormal evacuation pattern on manometry, abnormal balloon expulsion test or impaired rectal evacuation by imaging. It includes two subtypes; dyssynergic defecation and inadequate defecatory propulsion. Pelvic floor biofeedback therapy is effective for treating LAS and defecatory disorders. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

  13. The EpiNo® Device: Efficacy, Tolerability, and Impact on Pelvic Floor—Implications for Future Research

    PubMed Central

    Kavvadias, Tilemachos; Hoesli, Irene

    2016-01-01

    Aims. The aim of this review is to provide a comprehensive overview of the available literature on preventing perineal trauma with the EpiNo. Methods. We perfomed a literature research in the MedLine and EMBASE databases for studies referring to EpiNo published between 1990 and 2014, without restrictions for language and study type. Results. Five published studies were identified, regarding the effect of EpiNo on the rate of episiotomy and perineal tears, pelvic floor muscle function, and fetal outcome. The device seems to reduce episiotomy and perineal tears' rate, as well as the risk for levator ani microtrauma and avulsion, though not always statistically significant. It does not seem to have an effect on duration of second stage of labour and fetal outcome. The device is well tolerated and the adverse events are rare and mild. However, design and reporting bias in the reviewed articles do not allow evidence based conclusions. Conclusions. The EpiNo device seems to be promising, with potential positive effects on natural birth, while being uncomplicated to use and without major complications. Well designed, randomized trials are needed in order to understand the effects of EpiNo on pelvic floor and make evidence based recommendations on its use. PMID:26981126

  14. The Impact of Exogenic Testosterone and Nortestosterone-Decanoate Toxicological Evaluation Using a Rat Model

    PubMed Central

    Cristina, Romeo Teodor; Hanganu, Flavia; Dumitrescu, Eugenia; Muselin, Florin; Butnariu, Monica; Constantin, Adriana; Chiurciu, Viorica

    2014-01-01

    The impact of exogenic testosterone (T): 1.5 and 3.0 mg/kg.bw) and 19-nortestosterone 17-decanoate (ND): 1.5 and 7.5 mg/kg.bw) in castrated male rats was evaluated based on: (a) weight increase of the androgen target tissues, respecting the Hershberger methodology; (b) the 17α and β-testosterone, 17 α and β-estradiol and 17 α and β-nortestosterone levels using the GC-MS/MS technique; and (c) observation of the serum free thyroxine levels (T4). Results revealed that T and ND significantly increased the weight of androgen target tissues as follows: ND was more influential on seminal vesicles, levator ani-bulbocavernosus muscle (LABC) and Cowper's glands and T (at a dose of 3.0 mg/kg.bw) influenced the weight of the ventral prostate and glans penis. Serum samples analyzed for steroid hormone levels showed the presence of 17β-testosterone, 17β-estradiol and 17β-nor-testosterone, in castrated male rats injected with testosterone and nortestosterone, but no significant differences were found between thyroid responses and thyroid hormone levels. The results of this research proved the disrupting activity of T and ND when administered in high doses and the useful application of the Hershberger bioassay in the case of ND. PMID:25302584

  15. Presynaptic Muscarinic Acetylcholine Receptors and TrkB Receptor Cooperate in the Elimination of Redundant Motor Nerve Terminals during Development.

    PubMed

    Nadal, Laura; Garcia, Neus; Hurtado, Erica; Simó, Anna; Tomàs, Marta; Lanuza, Maria A; Cilleros, Victor; Tomàs, Josep

    2017-01-01

    The development of the nervous system involves the overproduction of synapses but connectivity is refined by Hebbian activity-dependent axonal competition. The newborn skeletal muscle fibers are polyinnervated but, at the end of the competition process, some days later, become innervated by a single axon. We used quantitative confocal imaging of the autofluorescent axons from transgenic B6.Cg-Tg (Thy1-YFP)16 Jrs/J mice to investigate the possible cooperation of the muscarinic autoreceptors (mAChR, M 1 -, M 2 - and M 4 -subtypes) and the tyrosine kinase B (TrkB) receptor in the control of axonal elimination after the mice Levator auris longus (LAL) muscle had been exposed to several selective antagonist of the corresponding receptor pathways in vivo . Our previous results show that M 1 , M 2 and TrkB signaling individually increase axonal loss rate around P9. Here we show that although the M 1 and TrkB receptors cooperate and add their respective individual effects to increase axonal elimination rate even more, the effect of the M 2 receptor is largely independent of both M 1 and TrkB receptors. Thus both, cooperative and non-cooperative signaling mechanisms contribute to developmental synapse elimination.

  16. Presynaptic Muscarinic Acetylcholine Receptors and TrkB Receptor Cooperate in the Elimination of Redundant Motor Nerve Terminals during Development

    PubMed Central

    Nadal, Laura; Garcia, Neus; Hurtado, Erica; Simó, Anna; Tomàs, Marta; Lanuza, Maria A.; Cilleros, Victor; Tomàs, Josep

    2017-01-01

    The development of the nervous system involves the overproduction of synapses but connectivity is refined by Hebbian activity-dependent axonal competition. The newborn skeletal muscle fibers are polyinnervated but, at the end of the competition process, some days later, become innervated by a single axon. We used quantitative confocal imaging of the autofluorescent axons from transgenic B6.Cg-Tg (Thy1-YFP)16 Jrs/J mice to investigate the possible cooperation of the muscarinic autoreceptors (mAChR, M1-, M2- and M4-subtypes) and the tyrosine kinase B (TrkB) receptor in the control of axonal elimination after the mice Levator auris longus (LAL) muscle had been exposed to several selective antagonist of the corresponding receptor pathways in vivo. Our previous results show that M1, M2 and TrkB signaling individually increase axonal loss rate around P9. Here we show that although the M1 and TrkB receptors cooperate and add their respective individual effects to increase axonal elimination rate even more, the effect of the M2 receptor is largely independent of both M1 and TrkB receptors. Thus both, cooperative and non-cooperative signaling mechanisms contribute to developmental synapse elimination. PMID:28228723

  17. Presynaptic muscarinic receptors, calcium channels, and protein kinase C modulate the functional disconnection of weak inputs at polyinnervated neonatal neuromuscular synapses.

    PubMed

    Santafe, M M; Garcia, N; Lanuza, M A; Tomàs, M; Besalduch, N; Tomàs, J

    2009-04-01

    We studied the relation among calcium inflows, voltage-dependent calcium channels (VDCC), presynaptic muscarinic acetylcholine receptors (mAChRs), and protein kinase C (PKC) activity in the modulation of synapse elimination. We used intracellular recording to determine the synaptic efficacy in dually innervated endplates of the levator auris longus muscle of newborn rats during axonal competition in the postnatal synaptic elimination period. In these dual junctions, the weak nerve terminal was potentiated by partially reducing calcium entry (P/Q-, N-, or L-type VDCC-specific block or 500 muM magnesium ions), M1- or M4-type selective mAChR block, or PKC block. Moreover, reducing calcium entry or blocking PKC or mAChRs results in unmasking functionally silent nerve endings that now recover neurotransmitter release. Our results show interactions between these molecules and indicate that there is a release inhibition mechanism based on an mAChR-PKC-VDCC intracellular cascade. When it is fully active in certain weak motor axons, it can depress ACh release and even disconnect synapses. We suggest that this mechanism plays a central role in the elimination of redundant neonatal synapses, because functional axonal withdrawal can indeed be reversed by mAChRs, VDCCs, or PKC block.

  18. Short-term effects of beta-amyloid25-35 peptide aggregates on transmitter release in neuromuscular synapses.

    PubMed

    Garcia, Neus; Santafé, Manel M; Tomàs, Marta; Lanuza, Maria A; Tomàs, Josep

    2008-03-01

    The beta-amyloid (AB) peptide25-35 contains the functional domain of the AB precursor protein that is both required for neurotrophic effects in normal neural tissues and is involved in the neurotoxic effects in Alzheimer disease. We demonstrated the presence of the amyloid precursor protein/AB peptide in intramuscular axons, presynaptic motor nerve terminals, terminal and myelinating Schwann cells, and the postsynaptic and subsarcolemmal region in the Levator auris longus muscle of adult rats by immunocytochemistry. Using intracellular recording, we investigated possible short-term functional effects of the AB fragment (0.1-10 micromol/L) on acetylcholine release in adult and newborn motor end plates. We found no change in evoked, spontaneous transmitter release or resting membrane potential of the muscle cells. A previous block of the presynaptic muscarinic receptor subtypes and a previous block or stimulation of protein kinase C revealed no masked effect of the peptide on the regulation of transmitter release. The aggregated form of AB peptide25-35, however, interfered acutely with acetylcholine release (quantal content reduction) when synaptic activity was maintained by electric stimulation. The possible relevance of this inhibition of neurotransmission by AB peptide25-35 to the pathogenesis of Alzheimer remains to be determined.

  19. A selective androgen receptor modulator with minimal prostate hypertrophic activity restores lean body mass in aged orchidectomized male rats.

    PubMed

    Allan, George; Sbriscia, Tifanie; Linton, Olivia; Lai, Muh-Tsann; Haynes-Johnson, Donna; Bhattacharjee, Sheela; Ng, Raymond; Sui, Zhihua; Lundeen, Scott

    2008-06-01

    Androgens are required for the maintenance of normal sexual activity in adulthood and for enhancing muscle growth and lean body mass in adolescents and adults. Androgen receptor (AR) ligands with tissue selectivity (selective androgen receptor modulators, or SARMs) have potential for treating muscle wasting, hypogonadism of aging, osteoporosis, female sexual dysfunction, and other indications. JNJ-37654032 is a nonsteroidal AR ligand with mixed agonist and antagonist activity in androgen-responsive cell-based assays. It is an orally active SARM with muscle selectivity in orchidectomized rat models. It stimulated growth of the levator ani muscle with ED(50) 0.8 mg/kg, stimulating maximal growth at a dose of 3mg/kg. In contrast, it stimulated ventral prostate growth to 21% of its full size at 3mg/kg. At the same time, JNJ-37654032 reduced prostate weight in intact rats by 47% at 3mg/kg, while having no inhibitory effect on muscle. Using magnetic resonance imaging to monitor body composition, JNJ-37654032 restored about 20% of the lean body mass lost following orchidectomy in aged rats. JNJ-37654032 reduced follicle-stimulating hormone levels in orchidectomized rats and reduced testis size in intact rats. JNJ-37654032 is a potent prostate-sparing SARM with the potential for clinical benefit in muscle-wasting diseases.

  20. A selective androgen receptor modulator with minimal prostate hypertrophic activity enhances lean body mass in male rats and stimulates sexual behavior in female rats.

    PubMed

    Allan, George F; Tannenbaum, Pamela; Sbriscia, Tifanie; Linton, Olivia; Lai, Muh-Tsann; Haynes-Johnson, Donna; Bhattacharjee, Sheela; Zhang, Xuqing; Sui, Zhihua; Lundeen, Scott G

    2007-08-01

    Androgen receptor (AR) ligands with tissue selectivity (selective androgen receptor modulators, or SARMs) have potential for treating muscle wasting, hypogonadism of aging, osteoporosis, female sexual dysfunction, and other indications. JNJ-28330835 is a nonsteroidal AR ligand with mixed agonist and antagonist activity in androgen-responsive cell-based assays. It is an orally active SARM with muscle selectivity in orchidectomized rat models. It stimulated growth of the levator ani muscle, stimulating maximal growth at a dose of 10 mg/kg. At the same time, JNJ-28330835 reduced prostate weight in intact rats by a mean of 30% at 10 mg/kg, while having no inhibitory effect on muscle. Using magnetic resonance imaging (MRI) to monitor body composition, it prevented half of the loss of lean body mass associated with orchidectomy, and restored about 30% of lost lean mass to aged orchidectomized rats. It had agonist effects on markers of both osteoclast and osteoblast activity, suggesting that it reduces bone turnover. In a model of sexual behavior, JNJ-28330835 enhanced the preference of ovariectomized female rats for sexually intact male rats over nonsexual orchidectomized males. JNJ-28330835 is a prostate-sparing SARM with the potential for clinically beneficial effects in muscle-wasting diseases and sexual function disorders.

  1. The anatomy and ontogeny of the head, neck, pectoral, and upper limb muscles of Lemur catta and Propithecus coquereli (primates): discussion on the parallelism between ontogeny and phylogeny and implications for evolutionary and developmental biology.

    PubMed

    Diogo, Rui; Molnar, Julia L; Smith, Timothy D

    2014-08-01

    Most anatomical studies of primates focus on skeletal tissues, but muscular anatomy can provide valuable information about phylogeny, functional specializations, and evolution. Herein, we present the first detailed description of the head, neck, pectoral, and upper limb muscles of the fetal lemuriforms Lemur catta (Lemuridae) and Propithecus coquereli (Indriidae). These two species belong to the suborder Strepsirrhini, which is often presumed to possess some plesiomorphic anatomical features within primates. We compare the muscular anatomy of the fetuses with that of infants and adults and discuss the evolutionary and developmental implications. The fetal anatomy reflects a phylogenetically more plesiomorphic condition in nine of the muscles we studied and a more derived condition in only two, supporting a parallel between ontogeny and phylogeny. The derived exceptions concern muscles with additional insertions in the fetus which are lost in adults of the same species, that is, flexor carpi radialis inserts on metacarpal III and levator claviculae inserts on the clavicle. Interestingly, these two muscles are involved in movements of the pectoral girdle and upper limb, which are mainly important for activities in later stages of life, such as locomotion and prey capture, rather than activities in fetal life. Accordingly, our findings suggest that some exceptions to the "ontogeny parallels phylogeny" rule are probably driven more by ontogenetic constraints than by adaptive plasticity. © 2014 Wiley Periodicals, Inc.

  2. Early postnatal response of the spinal nucleus of the bulbocavernosus and target muscles to testosterone in male gerbils.

    PubMed

    Hadi Mansouri, S; Siegford, Janice M; Ulibarri, Catherine

    2003-05-14

    This study examined the response of the spinal nucleus of the bulbocavernosus (SNB) and the bulbocavernosus (BC) muscle, to testosterone in male Mongolian gerbils (Meriones unguiculatus) during the early postnatal period. Male gerbil pups were given testosterone propionate (TP) or vehicle for 2 days, then perfused on postnatal day (PND) 3, 5, 10 or 15. The BC and levator ani (LA) muscles were removed, weighed, and sectioned. Cross-sections of BC muscle fibers were measured and muscle fiber morphology examined. Spinal cords were removed and coronally sectioned in order to count and measure the SNB motoneurons. Following TP treatment, male pups of all ages had significantly heavier BC-LA muscles and larger fibers in the BC muscle compared to age-matched controls. The increase in muscle weight following TP treatment was greatest at PND10, while fiber size increased to a similar degree at all ages suggesting that hyperplasia as well as hypertrophy was responsible for the increase in muscle mass at this time. SNB motoneurons increased significantly in number and size with age and TP treatment. We hypothesize that the increase in SNB motoneuron number during normal ontogeny that can be augmented by TP treatment and represents an unusual means of establishing sexual dimorphism in the nervous system of a mammal through cell recruitment to the motor pool of a postnatal animal.

  3. That "poker face" just might lose you the game! The impact of expressive suppression and mimicry on sensitivity to facial expressions of emotion.

    PubMed

    Schneider, Kristin G; Hempel, Roelie J; Lynch, Thomas R

    2013-10-01

    Successful interpersonal functioning often requires both the ability to mask inner feelings and the ability to accurately recognize others' expressions--but what if effortful control of emotional expressions impacts the ability to accurately read others? In this study, we examined the influence of self-controlled expressive suppression and mimicry on facial affect sensitivity--the speed with which one can accurately identify gradually intensifying facial expressions of emotion. Muscle activity of the brow (corrugator, related to anger), upper lip (levator, related to disgust), and cheek (zygomaticus, related to happiness) were recorded using facial electromyography while participants randomized to one of three conditions (Suppress, Mimic, and No-Instruction) viewed a series of six distinct emotional expressions (happiness, sadness, fear, anger, surprise, and disgust) as they morphed from neutral to full expression. As hypothesized, individuals instructed to suppress their own facial expressions showed impairment in facial affect sensitivity. Conversely, mimicry of emotion expressions appeared to facilitate facial affect sensitivity. Results suggest that it is difficult for a person to be able to simultaneously mask inner feelings and accurately "read" the facial expressions of others, at least when these expressions are at low intensity. The combined behavioral and physiological data suggest that the strategies an individual selects to control his or her own expression of emotion have important implications for interpersonal functioning.

  4. Coccygodynia - pathogenesis, diagnostics and therapy. Review of the writing.

    PubMed

    Dampc, Bogumiła; Słowiński, Krzysztof

    2017-08-31

    Coccygodynia is a problem with a small percentage (1%) of the population suffering from musculoskeletal disorders. This pain is often associated with trauma, falling on the tailbone, long cycling, or by women after childbirth. The reason for the described problem can be the actual morphological changes. Idiopathic coccygodynia causes therapeutic difficulties to specialists of many fields. Unsatisfactory treatment, including coccygectomy tends to seek new solutions. They belong to them techniques exploited in the manual therapy which in their spectrum hold: direct techniques - per rectum as well as indirect techniques taking into account distant structures of the motor organ, remaining in dense interactions with the coccygeal part. Idiopathic coccygodynia is a result perhaps from exaggerated tension the muscle of the levator ani, coccygeus and gluteus maximus as well as from irritating soft tissue structures surrounding the coccyx: of sacrococcygeum, sacrospinale, and sacrotuberale ligament. Unfortunately we can't see them in objective examinations so as: the RTG, MR or TK, therefore constitute the both diagnostic and therapeutic problem. For describing the problem a writing of the object was used both from the field of the surgery and of manual therapy. Detailed and multifaceted knowledge about causes of the described problem allows more accurately to categorize the patient to the appropriate group and helps to select the best procedure of treatment.

  5. Modulation of the cytosolic androgen receptor in striated muscle by sex steroids

    NASA Technical Reports Server (NTRS)

    Rance, N. E.; Max, S. R.

    1984-01-01

    The effects of orchiectomy (GDX) and of subsequent administration of testosterone propionate (TP) or 17(beta)-estradiol (E2) on the maximum binding (Bmax) and apparent Kd of the cytosolic androgen receptor in levator ani (LA) and skeletal muscles of adult male Sprague-Dawley rats are investigated experimentally. The results are presented in graphs and discussed. In LA, BMAX is found to rise from a control level of 2.5 fmol/mg protein to 280, 600, 478, and 133 percent of control at 12 h, 14 d, 30 d, and 44 d after GDX, respectively, while Kd increased only insignificantly (from 680 to 960 fM); Bmax is held at control levels for 6 h by cycloheximide given at GDX, is unaffected by TP given at 30 d, and is further increased (by 480 percent at 44 d) by administration of E2 at 30 d. Bmax in skeletal muscles is found to increase to 139, 212, 220, and 158 percent of control at 12 h, 14 d, 30 d, and 44 d, respectively; Bmax is returned to control at 44 d by TP at 30 d but is not affected by E2. The effect of E2 in LA is attributed to either induction of the cytosolic receptor or a decreased rate of receptor degradation.

  6. Effects of postnatal administration of diethylstilbestrol on puberty and thyroid function in male rats.

    PubMed

    Shin, Jae-Ho; Kim, Tae Sung; Kang, Il Hyun; Kang, Tae Seok; Moon, Hyun Ju; Han, Soon-Young

    2009-10-01

    To examine the effects of diethylstilbestrol (DES) on male pubertal development and thyroid function, juvenile male Sprague-Dawley rats were given DES daily by oral intubation at doses of 10, 20 and 40 microg/kg/day from postnatal day 33 for 20 days. Prepuce separation was significantly delayed at the dose of 20 microg/kg/day and above in the DES-treated rats. DES treatment induced a significant reduction in the weights of testes, epididymides, the ventral prostate, seminal vesicles plus coagulating glands and fluid, levator ani bulbocavernosus muscles, Cowper's glands and the glans penis. The weights of the liver and adrenals increased in the DES-treated animals. DES caused a dose-dependent reduction in germ cells; in particular the spermatids were mainly affected. The serum levels of testosterone and luteinizing hormone were significantly reduced in the DES-treated groups, but that of estradiol decreased. No differences were observed in the serum thyroxine levels of the control and DES-treated groups. In microscopic observation of the DES-treated animals, degeneration of germ cells and tubular atrophy in the testis were noted, but there were no microscopic changes in the thyroid. These results indicate that DES affected the pubertal development of juvenile male rats and that its mode of action may be related to alterations in hormone levels.

  7. Genetically-induced Estrogen Receptor Alpha mRNA (Esr1) Overexpression Does Not Adversely Affect Fertility or Penile Development in Male Mice

    PubMed Central

    Heath, John; Abdelmageed, Yazeed; Braden, Tim D.; Williams, Carol S.; Williams, John W.; Paulose, Tessie; Hernandez-Ochoa, Isabel; Gupta, Rupesh; Flaws, Jodi A.; Goyal, Hari O.

    2011-01-01

    Previously, we reported that estrogen receptor alpha mRNA (Esr1) or protein (ESR1) overexpression resulting from neonatal exposure to estrogens in rats was associated with infertility and mal-developed penis characterized by reduced length and weight and abnormal accumulation of fat cells. The objective of this study was to determine if mutant male mice overexpressing Esr1 are naturally infertile or have reduced fertility and/or develop abnormal penis. The fertility parameters, including fertility and fecundity indices, numbers of days from the day of cohabitation to the day of delivery, and numbers of pups per female, were not altered from controls, as a result of Esr1 overexpression. Likewise, penile morphology, including the length, weight, and diameter and os penis development, was not altered from controls. Conversely, weights of the seminal vesicles and bulbospongiosus and levator ani (BS/LA) muscles were significantly (P < 0.05) lower as compared to controls; however, the weight of the testis, the morphology of the testis and epididymis, and the plasma and testicular testosterone concentration were not different from controls. Hence, the genetically-induced Esr1 overexpression alone, without an exogenous estrogen exposure during the neonatal period, is unable to adversely affect the development of the penis as well as other male reproductive organs, except limited, but significant, reductions in weights of the seminal vesicles and BS/LA muscles. PMID:20930192

  8. Muscle-specific androgen receptor deletion shows limited actions in myoblasts but not in myofibers in different muscles in vivo.

    PubMed

    Rana, Kesha; Chiu, Maria W S; Russell, Patricia K; Skinner, Jarrod P; Lee, Nicole K L; Fam, Barbara C; Zajac, Jeffrey D; MacLean, Helen E

    2016-08-01

    The aim of this study was to investigate the direct muscle cell-mediated actions of androgens by comparing two different mouse lines. The cre-loxP system was used to delete the DNA-binding activity of the androgen receptor (AR) in mature myofibers (MCK mAR(ΔZF2)) in one model and the DNA-binding activity of the AR in both proliferating myoblasts and myofibers (α-actin mAR(ΔZF2)) in another model. We found that hind-limb muscle mass was normal in MCK mAR(ΔZF2) mice and that relative mass of only some hind-limb muscles was reduced in α-actin mAR(ΔZF2) mice. This suggests that myoblasts and myofibers are not the major cellular targets mediating the anabolic actions of androgens on male muscle during growth and development. Levator ani muscle mass was decreased in both mouse lines, demonstrating that there is a myofiber-specific effect in this unique androgen-dependent muscle. We found that the pattern of expression of genes including c-myc, Fzd4 and Igf2 is associated with androgen-dependent changes in muscle mass; therefore, these genes are likely to be mediators of anabolic actions of androgens. Further research is required to identify the major targets of androgen actions in muscle, which are likely to include indirect actions via other tissues. © 2016 Society for Endocrinology.

  9. A biological micro actuator: graded and closed-loop control of insect leg motion by electrical stimulation of muscles.

    PubMed

    Cao, Feng; Zhang, Chao; Vo Doan, Tat Thang; Li, Yao; Sangi, Daniyal Haider; Koh, Jie Sheng; Huynh, Ngoc Anh; Bin Aziz, Mohamed Fareez; Choo, Hao Yu; Ikeda, Kazuo; Abbeel, Pieter; Maharbiz, Michel M; Sato, Hirotaka

    2014-01-01

    In this study, a biological microactuator was demonstrated by closed-loop motion control of the front leg of an insect (Mecynorrhina torquata, beetle) via electrical stimulation of the leg muscles. The three antagonistic pairs of muscle groups in the front leg enabled the actuator to have three degrees of freedom: protraction/retraction, levation/depression, and extension/flexion. We observed that the threshold amplitude (voltage) required to elicit leg motions was approximately 1.0 V; thus, we fixed the stimulation amplitude at 1.5 V to ensure a muscle response. The leg motions were finely graded by alternation of the stimulation frequencies: higher stimulation frequencies elicited larger leg angular displacement. A closed-loop control system was then developed, where the stimulation frequency was the manipulated variable for leg-muscle stimulation (output from the final control element to the leg muscle) and the angular displacement of the leg motion was the system response. This closed-loop control system, with an optimized proportional gain and update time, regulated the leg to set at predetermined angular positions. The average electrical stimulation power consumption per muscle group was 148 µW. These findings related to and demonstrations of the leg motion control offer promise for the future development of a reliable, low-power, biological legged machine (i.e., an insect-machine hybrid legged robot).

  10. Surface electromyography analysis of blepharoptosis correction by transconjunctival incisions.

    PubMed

    Tu, Lung-Chen; Wu, Ming-Chya; Chu, Hsueh-Liang; Chiang, Yi-Pin; Kuo, Chih-Lin; Li, Hsing-Yuan; Chang, Chia-Ching

    2016-06-01

    Upper eyelid movement depends on the antagonistic actions of orbicularis oculi muscle and levator aponeurosis. Blepharoptosis is an abnormal drooping of upper eyelid margin with the eye in primary position of gaze. Transconjunctival incisions for upper eyelid ptosis correction have been a well-developed technique. Conventional prognosis however depends on clinical observations and lacks of quantitatively analysis for the eyelid muscle controlling. This study examines the possibility of using the assessments of temporal correlation in surface electromyography (SEMG) as a quantitative description for the change of muscle controlling after operation. Eyelid SEMG was measured from patients with blepharoptosis preoperatively and postoperatively, as well as, for comparative study, from young and aged normal subjects. The data were analyzed using the detrended fluctuation analysis method. The results show that the temporal correlation of the SEMG signals can be characterized by two indices associated with the correlation properties in short and long time scales demarcated at 3ms, corresponding to the time scale of neural response. Aging causes degradation of the correlation properties at both time scales, and patient group likely possess more serious correlation degradation in long-time regime which was improved moderately by the ptosis corrections. We propose that the temporal correlation in SEMG signals may be regarded as an indicator for evaluating the performance of eyelid muscle controlling in postoperative recovery. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Pregnancy impact on uterosacral ligament and pelvic muscles using a 3D numerical and finite element model: preliminary results.

    PubMed

    Jean Dit Gautier, Estelle; Mayeur, Olivier; Lepage, Julien; Brieu, Mathias; Cosson, Michel; Rubod, Chrystele

    2018-03-01

    We studied the geometry of and changes in structures that play an important role in stabilizing the pelvic system during pregnancy using a numerical system at different gestational ages and postpartum. We developed a parturient numerical model to assess pelvic structures at different gestational stages (16, 32, and 38 weeks) and postpartum (2 months and 1 year) using magnetic resonance imaging (MRI). Organs, muscles, and ligaments were segmented to generate a 3D model of the pelvis. We studied changes in the length of uterosacral ligaments (USL) and thickness of the puborectal portion of the levator ani muscle (LAM) during and after pregnancy. We used this model to perform finite element (FE) simulation and analyze deformations of these structures under stress from the increase in uterine weight. Analysis reveals an increase in the length of US ligaments at 16, 32, and 38 weeks. Two months after delivery, it decreases without returning to the length at 16 weeks of pregnancy. Similar changes were observed for the puborectal portion of the LAM. Variations observed in these structures are not equivalent to other anatomical structures of pelvic suspension. FE simulation with increased uterus weight does not lead to those findings. This analysis brings new elements and a new focus for discussion relating to changes in pelvic balance of parturient women that are not simply linked to the increase in uterine volume.

  12. Effectiveness of adding voluntary pelvic floor muscle contraction to a Pilates exercise program: an assessor-masked randomized controlled trial.

    PubMed

    Torelli, Luiza; de Jarmy Di Bella, Zsuzsanna Ilona Katalin; Rodrigues, Claudinei Alves; Stüpp, Liliana; Girão, Manoel João Batista Castello; Sartori, Marair Gracio Ferreira

    2016-11-01

    The purpose of this study was to evaluate the effectiveness of adding voluntary pelvic floor muscle contraction (PFMC) to a Pilates exercise program in sedentary nulliparous women. Fifty-seven healthy nulliparous and physically inactive women were randomized to a Pilates exercise program (PEP) with or without PFMC. Forty-eight women concluded this study (24 participants for each group). Each woman was evaluated before and after the PEP, by a physiotherapist and an urogynecologist (UG). Neither of the professionals was revealed to them. This physiotherapist measured their pelvic floor muscle strength by using both a perineometer (Peritron) and vaginal palpation (Oxford Scale). The UG, who performed 3D perineal ultrasound examinations, collected their data and evaluated the results for pubovisceral muscle thickness and the levator hiatus area (LA). Both professionals were blinded to the group allocation. The protocol for both groups consisted of 24 bi-weekly 1-h individual sessions of Pilates exercises, developed by another physiotherapist who specializes in PFM rehabilitation and the Pilates technique. The PEP+ PFMC group showed significantly greater strength improvements than the PEP group when comparing the Oxford scale, vaginal pressure and pubovisceral muscle thickness during contraction measurements at baseline and post-treatment. Our findings suggest that adding a voluntary PFMC to a Pilates exercise program is more effective than Pilates alone in improving PFM strength in sedentary nulliparous women.

  13. Estrogenic and anti-androgenic activities of 4-nitrophenol in diesel exhaust particles

    SciTech Connect

    Li Chunmei; Laboratory of Veterinary Physiology, Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509; Taneda, Shinji

    2006-11-15

    A 4-nitrophenol (PNP) isolated from diesel exhaust particles (DEP) has been identified as a vasodilator. PNP is also a known degradation product of the insecticide parathion. We used uterotrophic and Hershberger assays to study the estrogenic and anti-androgenic activities of PNP in-vivo. In ovariectomized immature female rats injected subcutaneously with 1, 10, or 100 mg/kg PNP daily for 7 days, significant (P < 0.05) increases in uterine weight were seen in only those receiving 10 or 100 mg/kg PNP. Furthermore, in castrated immature male rats implanted with a silastic tube (length, 5 mm) containing crystalline testosterone and injected subcutaneously withmore » 0.01, 0.1, or 1 mg/kg PNP daily for 5 days, those receiving the doses of 0.1 mg/kg showed significant (P < 0.05) weight decreases in seminal vesicles, ventral prostate, levator ani plus bulbocavernosus muscles, and glans penis. Plasma FSH and LH levels did not change in female rats but were significantly (P < 0.05) increased in male rats treated with 0.1 mg/kg PNP. These results clearly demonstrated that PNP has estrogenic and anti-androgenic activities in-vivo. Our results therefore suggest that diesel exhaust emissions and the degradation of parathion can lead to accumulation of PNP in air, water, and soil and thus could have serious deleterious effects on wildlife and human health.« less

  14. Cytoarchitecture of steroid dependent target tissues after testosterone administration compared to nandrolone decanoate in castrated rats in the aim of Hershberger bio test.

    PubMed

    Cristina, Romeo Teodor; Hanganu, Flavia; Brezovan, Diana; Dumitrescu, Eugenia; Muselin, Florin; Chiurciu, Viorica; Stancu, Adrian Constantin; Pentea, Marius Cristian; Motoc, Andrei Gheorghe Marius

    2014-01-01

    The objective was the cytoarchitecture evaluation of known steroid dependent target tissues after administering of testosterone, compared to action of its more active ester, nortestosterone (nandrolone decanoate) in castrated rat males in the aim of Hershberger bio test. Study was performed on 30 castrated male Wistar rats, aged between 35 and 39 days, in peripubertal period, divided into five groups. Androgen doses administration begun at the rats' age of 49 days. Animals were injected i.m., daily, for 10 consecutive days as follows: Aquatest (Balkan Pharmaceuticals Ltd., Moldova) testosterone aqueous solution: Testosterone I group (0.4 mg/animal); Testosterone II (0.8 mg/animal); (Deca-Durabolin, Balkan Pharmaceuticals); nandrolone decanoate oily solution: Nortestosterone I (1.5 mg/kg body weight); Nortestosterone II (7.5 mg/kg body weight) and Control (White sesame oil, Manicos, Romania, 0.1 mL/animal). Gonadectomy (GDX) induced modifications of target tissues wet weight accompanied by important modifications in cytoarchitecture. Changes following exogenous administration of testosterone and nortestosterone decanoate were found in: liver (granular dystrophy, mega-mitochondria, tubular intumescences), prostate (increasing of the structural elements), seminal vesicles (hyalinosis, thickening of cell walls and the hyaline presence), levator ani-bulbo-cavernosus muscle (muscle fibbers dilacerations), bulbourethral glands (muscular fibbers rarefaction by fluid accumulation) demonstrating the disruptor activity especially for overdosed nandrolone decanoate.

  15. Clinical trial comparing autogenous fascia lata sling and Gore-Tex suspension in bilateral congenital ptosis.

    PubMed

    Elsamkary, Mahmoud Ahmed; Roshdy, Maged Maher Salib

    2016-01-01

    To study the effect of autogenous fascia lata sling (AFLS) versus Gore-Tex suspension (GTS) regarding the functional and aesthetic outcomes in patients with bilateral congenital ptosis. A prospective comparative randomized single-center study enrolled 110 patients with bilateral congenital ptosis. One group (n=55) underwent AFLS and the second group (n=55) underwent GTS. Exclusion criteria were good levator function, absent Bell's phenomenon, and abnormal ocular motility. Follow-up period was 2 years. Functional outcome was measured from digital photos by analysis of upper eyelid margin position relative to the superior limbus and classified as very good (<3 mm), good (3-5 mm), poor (>5 mm), and recurrent. Aesthetic outcome was assessed in terms of lid contour, symmetry of eyelid height, and lid crease presence. Complications were also reported. Failure rate (recurrence and complications) was less in AFLS (P=0.035). Symmetrical lid height and good contour were more frequently attained by AFLS (P=0.007 and 0.047, respectively). However, the frequency of very good, good, poor, recurrence, lagopthalmos, ectropion, infection, and formed lid crease individually showed no statistically significant difference (P=0.252, 0.482, 1, 0.489, 0.438, 1, 0.618, and 0.506, respectively). AFLS is a better choice in surgery for patients with bilateral congenital ptosis because it has fewer complications and a lesser recurrence rate than GTS.

  16. Selective stimulation of facial muscles with a penetrating electrode array in the feline model

    PubMed Central

    Sahyouni, Ronald; Bhatt, Jay; Djalilian, Hamid R.; Tang, William C.; Middlebrooks, John C.; Lin, Harrison W.

    2017-01-01

    Objective Permanent facial nerve injury is a difficult challenge for both patients and physicians given its potential for debilitating functional, cosmetic, and psychological sequelae. Although current surgical interventions have provided considerable advancements in facial nerve rehabilitation, they often fail to fully address all impairments. We aim to introduce an alternative approach to facial nerve rehabilitation. Study design Acute experiments in animals with normal facial function. Methods The study included three anesthetized cats. Four facial muscles (levator auris longus, orbicularis oculi, nasalis, and orbicularis oris) were monitored with a standard electromyographic (EMG) facial nerve monitoring system with needle electrodes. The main trunk of the facial nerve was exposed and a 16-channel penetrating electrode array was placed into the nerve. Electrical current pulses were delivered to each stimulating electrode individually. Elicited EMG voltage outputs were recorded for each muscle. Results Stimulation through individual channels selectively activated restricted nerve populations, resulting in selective contraction of individual muscles. Increasing stimulation current levels resulted in increasing EMG voltage responses. Typically, selective activation of two or more distinct muscles was successfully achieved via a single placement of the multi-channel electrode array by selection of appropriate stimulation channels. Conclusion We have established in the animal model the ability of a penetrating electrode array to selectively stimulate restricted fiber populations within the facial nerve and to selectively elicit contractions in specific muscles and regions of the face. These results show promise for the development of a facial nerve implant system. PMID:27312936

  17. Allometric shape change of the lower pharyngeal jaw correlates with a dietary shift to piscivory in a cichlid fish.

    PubMed

    Hellig, Christoph J; Kerschbaumer, Michaela; Sefc, Kristina M; Koblmüller, Stephan

    2010-07-01

    The morphological versatility of the pharyngeal jaw of cichlid fishes is assumed to represent a key factor facilitating their unparalleled trophic diversification and explosive radiation. It is generally believed that the functional design of an organism relates to its ecology, and thus, specializations to different diets are typically associated with distinct morphological designs, especially manifested in the cichlids' pharyngeal jaw apparatus. Thereby, the lower pharyngeal jaw (LPJ) incorporates some of the most predictive features for distinct diet-related morphotypes. Thus, considering that piscivorous cichlids experience an ontogenetic dietary shift from typically various kinds of invertebrates to fish, concomitant morphological changes in the LPJ are expected. Using Lepidiolamprologus elongatus, a top predator in the shallow rocky habitat of Lake Tanganyika, as model, and applying geometric and traditional morphometric techniques, we demonstrate an allometric change in ontogenetic LPJ shape development coinciding with the completion of the dietary shift toward piscivory. The piscivorous LPJ morphotype is initiated in juvenile fish by increasing elongation and narrowing of the LPJ and--when the fish reach a size of 80-90 mm standard length--further refined by the elongation of the posterior muscular processes, which serve as insertion for the fourth musculus levator externus. The enlarged muscular processes of the fully mature piscivorous morphotype provide for the construction of a powerful lever system, which allows the large individuals to process large prey fish and rely on exclusive piscivory.

  18. Distance between intramuscular nerve and artery in the extraocular muscles: a preliminary immunohistochemical study using elderly human cadavers.

    PubMed

    Kitamura, Kei; Cho, Kwang Ho; Jang, Hyung Suk; Murakami, Gen; Yamamoto, Masahito; Abe, Shin-Ichi

    2017-01-01

    Extraocular muscles are quite different from skeletal muscles in muscle fiber type and nerve supply; the small motor unit may be the most well known. As the first step to understanding the nerve-artery relationship, in this study we measured the distance from the arteriole (25-50 μm in thickness) to the nerve terminal twigs in extraocular muscles. With the aid of immunohistochemistry for nerves and arteries, we examined the arteriole-nerve distance at 10-15 sites in each of 68 extraocular muscles obtained from ten elderly cadavers. The oblique sections were nearly tangential to the muscle plate and included both global and orbital aspects of the muscle. In all muscles, the nerve twigs usually took a course parallel to muscle fibers, in contrast to most arterioles that crossed muscles. Possibly due to polyinnervation, an intramuscular nerve plexus was evident in four rectus and two oblique muscles. The arteriole-nerve distance usually ranged from 300 to 400 μm. However, individual differences were more than two times greater in each of seven muscles. Moreover, in each muscle the difference between sites sometimes reached 1 mm or more. The distance was generally shorter in the rectus and oblique muscles than in the levator palpebrae muscle, which reached statistical significance (p < 0.05). The differences in arteriole-nerve distances between sites within each muscle, between muscles, and between individuals might lead to an individual biological rhythm of fatigue in oculomotor performance.

  19. Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients.

    PubMed

    Schaake, Wouter; van der Schaaf, Arjen; van Dijk, Lisanne V; Bongaerts, Alfons H H; van den Bergh, Alfons C M; Langendijk, Johannes A

    2016-06-01

    Curative radiotherapy for prostate cancer may lead to anorectal side effects, including rectal bleeding, fecal incontinence, increased stool frequency and rectal pain. The main objective of this study was to develop multivariable NTCP models for these side effects. The study sample was composed of 262 patients with localized or locally advanced prostate cancer (stage T1-3). Anorectal toxicity was prospectively assessed using a standardized follow-up program. Different anatomical subregions within and around the anorectum were delineated. A LASSO logistic regression analysis was used to analyze dose volume effects on toxicity. In the univariable analysis, rectal bleeding, increase in stool frequency and fecal incontinence were significantly associated with a large number of dosimetric parameters. The collinearity between these predictors was high (VIF>5). In the multivariable model, rectal bleeding was associated with the anorectum (V70) and anticoagulant use, fecal incontinence was associated with the external sphincter (V15) and the iliococcygeal muscle (V55). Finally, increase in stool frequency was associated with the iliococcygeal muscle (V45) and the levator ani (V40). No significant associations were found for rectal pain. Different anorectal side effects are associated with different anatomical substructures within and around the anorectum. The dosimetric variables associated with these side effects can be used to optimize radiotherapy treatment planning aiming at prevention of specific side effects and to estimate the benefit of new radiation technologies. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. A novel concept for the surgical anatomy of the perineal body.

    PubMed

    Shafik, Ahmed; Sibai, Olfat El; Shafik, Ali A; Shafik, Ismail A

    2007-12-01

    Perineal body is considered by investigators as a fibromuscular structure that is the site of insertion of perineal muscles. We investigated the hypothesis that perineal body is the site across which perineal muscles pass uninterrupted from one side to the other. Perineal body was studied in 56 cadaveric specimens (46 adults, 10 neonatal deaths) by direct dissection with the help of magnifying loupe, fine surgical instruments, and bright light. Perineal body consisted of three layers: 1) superficial layer, which consisted of fleshy fibers of the external anal sphincter extending across perineal body to become the bulbospongiosus muscle; 2) tendinous extension of superficial transverse perineal muscle crossing perineal body to contralateral superficial transverse perineal muscle, with which it formed a criss-cross pattern; and 3) tendinous fibers of the deep transverse perineal muscle; the fibers crossing perineal body decussated in criss-cross pattern with the contralateral deep transverse perineal muscle. A relation of levator ani or puborectalis muscles to perineal body could not be identified. Perineal body (central perineal tendon) is not the site of insertion of perineal muscles but the site along which muscle fibers of these muscles and the external anal sphincter pass uninterrupted from one side to the other. Such a free passage from one muscle to the other seems to denote a "digastric pattern" for the perineal muscles. Perineal body is subjected to injury or continuous intra-abdominal pressure variations, which may eventually result in perineocele, enterocele, or sigmoidocele.

  1. Does vaginal delivery cause more damage to the pelvic floor than cesarean section as determined by 3D ultrasound evaluation? A systematic review.

    PubMed

    de Araujo, Camila Carvalho; Coelho, Suelene A; Stahlschmidt, Paulo; Juliato, Cassia R T

    2018-05-01

    Pregnancy and delivery are well-established risk factors for pelvic floor dysfunction (PFD), but the physiopathology, such as the delivery route, is not well understood. This study evaluated the impact of delivery route on the pelvic floor muscles via 3D ultrasound. This review is registered in the PROSPERO database. The criteria for inclusion were prospective studies with 3D translabial ultrasound assessment in primigravida women during pregnancy and postpartum published in English, Spanish or Portuguese between 1980 and 2016. We excluded studies that did not include the topic of urogenital hiatus measurement and literature reviews. The MeSH terms were obstetric delivery, postpartum period, labor, parturition, three-dimensional images, ultrasonography, pelvic floor, and pelvic floor disorders. The search retrieved 155 articles. After analysis, 6 articles were included. Four studies showed that vaginal delivery (VD) was associated with a larger hiatal area. One study associated the hiatal area with levator ani muscle (LAM) defects in VD. Four articles evaluated the bladder neck, 3 of which showed a significant increase in bladder neck mobility associated with VD and 1 showed decreased bladder neck elevation, not associated with the delivery mode; the first 3 articles all evaluated LAM injuries and showed an association between VD and LAM injury. Women who underwent VD presented defects of the puborectalis muscle. Vaginal delivery was associated with a higher number of LAM injuries, puborectalis defects, increased bladder neck mobility, and enlargement of the hiatal area.

  2. Allometric shape change of the lower pharyngeal jaw correlates with a dietary shift to piscivory in a cichlid fish

    NASA Astrophysics Data System (ADS)

    Hellig, Christoph J.; Kerschbaumer, Michaela; Sefc, Kristina M.; Koblmüller, Stephan

    2010-07-01

    The morphological versatility of the pharyngeal jaw of cichlid fishes is assumed to represent a key factor facilitating their unparalleled trophic diversification and explosive radiation. It is generally believed that the functional design of an organism relates to its ecology, and thus, specializations to different diets are typically associated with distinct morphological designs, especially manifested in the cichlids’ pharyngeal jaw apparatus. Thereby, the lower pharyngeal jaw (LPJ) incorporates some of the most predictive features for distinct diet-related morphotypes. Thus, considering that piscivorous cichlids experience an ontogenetic dietary shift from typically various kinds of invertebrates to fish, concomitant morphological changes in the LPJ are expected. Using Lepidiolamprologus elongatus, a top predator in the shallow rocky habitat of Lake Tanganyika, as model, and applying geometric and traditional morphometric techniques, we demonstrate an allometric change in ontogenetic LPJ shape development coinciding with the completion of the dietary shift toward piscivory. The piscivorous LPJ morphotype is initiated in juvenile fish by increasing elongation and narrowing of the LPJ and—when the fish reach a size of 80-90 mm standard length—further refined by the elongation of the posterior muscular processes, which serve as insertion for the fourth musculus levator externus. The enlarged muscular processes of the fully mature piscivorous morphotype provide for the construction of a powerful lever system, which allows the large individuals to process large prey fish and rely on exclusive piscivory.

  3. Multi-scale Finite Element Modeling of Eustachian Tube Function: Influence of Mucosal Adhesion

    PubMed Central

    Malik, J.E.; Swarts, J.D.; Ghadiali, S. N.

    2017-01-01

    The inability to open the collapsible Eustachian tube (ET) leads to the development of chronic Otitis Media (OM). Although mucosal inflammation during OM leads to increased mucin gene expression and elevated adhesion forces within the ET lumen, it is not known how changes in mucosal adhesion alter the biomechanical mechanisms of ET function. In this study, we developed a novel multi-scale finite element model of ET function in adults that utilizes adhesion spring elements to simulate changes in mucosal adhesion. Models were created for six adult subjects and dynamic patterns in muscle contraction were used to simulate the wave-like opening of the ET that occurs during swallowing. Results indicate that ET opening is highly sensitive to the level of mucosal adhesion and that exceeding a critical value of adhesion leads to rapid ET dysfunction. Parameter variation studies and sensitivity analysis indicate that increased mucosal adhesion alters the relative importance of several tissue biomechanical properties. For example, increases in mucosal adhesion reduced the sensitivity of ET function to tensor veli palatini muscle forces but did not alter the insensitivity of ET function to levator veli palatini muscle forces. Interestingly, although changes in cartilage stiffness did not significantly influence ET opening under low adhesion conditions, ET opening was highly sensitive to changes in cartilage stiffness under high adhesion conditions. Therefore, our multi-scale computational models indicate that changes in mucosal adhesion as would occur during inflammatory OM alter the biomechanical mechanisms of ET function. PMID:26891171

  4. An Exploratory Study to Determine the Relationship between Cervical Dysfunction and Perimenstrual Migraines

    PubMed Central

    Horwitz, Simone

    2015-01-01

    ABSTRACT Purpose: To determine whether an association between cervical dysfunction and perimenstrual migraines exists. Methods: Forty perimenstrual migraine sufferers and 46 controls were compared. Information on the participants' ages and perceptions of neck pain and stiffness were solicited. The blinded physical examination of the cervical area consisted of postural, range of motion, muscle strength, muscle length, trigger point, neural mobility, and segmental cervical joint movement assessment. Results: The migraine group had increased perception of neck pain and stiffness (p<0.001); reduced bilateral rotation (p=0.013); decreased muscle length in both trapezii, left sternocleidomastoid, and right occipitals (p=0.045); more pain on muscle stretch in both levator scapulae, both trapezii, left sternocleidomastoid, and both occipitals (p=0.013); increased trigger points bilaterally in the left trapezius (p=0.021), right trapezius (p=0.023), left sternocleidomastoid (p=0.0.004), and right sternocleidomastoid (p=0.021); reduced neural mobility with bilateral elbow lag (p=0.043); greater C4–C6 pain (p=0.045); and increased cervical stiffness in C5–C7 (p=0.023). There were no differences in posture and muscle strength. Decreased muscle length increased the risk of perimenstrual migraines 2.4–6.7 fold, reduced neural mobility 5.8–10.7 fold, and increased C7 stiffness 17.0 fold. Conclusion: The results suggest that an association between cervical dysfunction and perimenstrual headaches should be further explored. PMID:25931651

  5. Functional anorectal disorders.

    PubMed

    Bharucha, Adil E; Wald, Arnold; Enck, Paul; Rao, Satish

    2006-04-01

    This report defines criteria for diagnosing functional anorectal disorders (ie, fecal incontinence, anorectal pain, and disorders of defecation). Functional fecal incontinence is defined as the uncontrolled passage of fecal material recurring for > or =3 months in an individual with a developmental age of > or =4 years that is associated with: (1) abnormal functioning of normally innervated and structurally intact muscles, and/or (2) no or minor abnormalities of sphincter structure and/or innervation insufficient to explain fecal incontinence, and/or (3) normal or disordered bowel habits (ie, fecal retention or diarrhea), and/or (4) psychological causes. However, conditions wherein structural and/or neurogenic abnormalities explain the symptom, or are part of a generalized process (eg, diabetic neuropathy) are not included within functional fecal incontinence. Functional fecal incontinence is a common, but underrecognized symptom, which is equally prevalent in men and women, and can often cause considerable distress. The clinical features are useful for guiding diagnostic testing and therapy. Functional anorectal pain syndromes include proctalgia fugax (fleeting pain) and chronic proctalgia; chronic proctalgia may be subdivided into levator ani syndrome and unspecified anorectal pain, which are defined by arbitrary clinical criteria. Functional defecation disorders are characterized by 2 or more symptoms of constipation, with > or =2 of the following features during defecation: impaired evacuation, inappropriate contraction of the pelvic floor muscles, and inadequate propulsive forces. Functional disorders of defecation may be amenable to pelvic floor retraining by biofeedback therapy (such as dyssynergic defecation).

  6. Nerve supply to the internal anal sphincter differs from that to the distal rectum: an immunohistochemical study of cadavers.

    PubMed

    Kinugasa, Yusuke; Arakawa, Takashi; Murakami, Gen; Fujimiya, Mineko; Sugihara, Kenichi

    2014-04-01

    Fecal incontinence is a common problem after anal sphincter-preserving operations. The intersphincteric autonomic nerves supplying the internal anal sphincter (IAS) are formed by the union of: (1) nerve fibers from Auerbach's nerve plexus of the most distal part of the rectum and (2) the inferior rectal branches of the pelvic plexus (IRB-PX) running along the conjoint longitudinal muscle coat. The aim of the present study is to identify the detailed morphology of nerves to the IAS. The study comprised histological and immunohistochemical evaluations of paraffin-embedded sections from a large block of anal canal from the preserved 10 cadavers. The IRB-PX came from the superior aspect of the levator ani and ran into the anal canal on the anterolateral side. These nerves contained both sympathetic and parasympathetic fibers, but the sympathetic content was much higher than in nerves from the distal rectum. All intramural ganglion cells in the distal rectum were neuronal nitric oxide synthase-positive and tyrosine hydroxylase-negative and were restricted to above the squamous-columnar epithelial junction. Parasympathetic nerves formed a lattice-like plexus in the circular smooth muscles of the distal rectum, whereas the IAS contained short, longitudinally running sympathetic and parasympathetic nerves, although sympathetic nerves were dominant. The major autonomic nerve input to the IAS seemed not to originate from the distal rectum but from the IRB-PX. Injury to the IRB-PX during surgery seemed to result in loss of innervation to the major part of the IAS.

  7. Pelvic Floor Morphometric Differences in Elderly Women with or without Urinary Incontinence.

    PubMed

    Fradet, Sarah; Morin, Mélanie; Kruger, Jennifer; Dumoulin, Chantale

    2018-01-01

    Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but UI pathophysiology, specifically in elderly women, remains unclear. A better understanding of morphometric differences between continent and urinary incontinent elderly women is needed to improve the effectiveness of conservative treatment approaches. We hypothesized that morphometric differences in the pelvic floor muscles (PFM) among elderly women with and without UI could be observed using three- and four-dimensional (3D/4D) transperineal ultrasound (TPU) imaging. Method: A total of 40 elderly women (20 women with and 20 women without UI), with a mean age of 67.10 (SD 4.94) years, participated in the study. This was a case-control study in which TPU images were taken under three conditions: rest, maximal voluntary contraction (MVC), and Valsalva. Independent t -tests were conducted to compare measurements between the groups. Results: The study revealed statistically significant differences between the groups. At rest, the levator hiatal area and transverse diameter were bigger, and the PFM position was lower in the incontinent group. During MVC, all axial plane parameters were bigger in the incontinent group. In the sagittal plane, PFM position was again lower in the incontinent group. During Valsalva, the anorectal angle was wider in the women with incontinence. Conclusion: PFM morphometric differences were present and were observed using 3D/4D TPU imaging in elderly women with and without UI.

  8. Central nervous system abnormalities in vaginismus.

    PubMed

    Frasson, Emma; Graziottin, Alessandra; Priori, Alberto; Dall'ora, Elisa; Didonè, Giuseppe; Garbin, Emilio Luigi; Vicentini, Silvana; Bertolasi, Laura

    2009-01-01

    To investigate possible altered CNS excitability in vaginismus. In 10 patients with primary idiopathic lifelong vaginismus, 10 with vulvar vestibulitis syndrome accompanied by vaginismus and healthy controls we recorded EMG activity from the levator ani (LA) and external anal sphincter (EAS) muscles and tested bulbocavernosus reflex (BCR). Pudendal-nerve somatosensory evoked potentials (SEPs) were tested after a single stimulus. Pudendal-nerve SEP recovery functions were assessed using a paired conditioning-test paradigm at interstimulus intervals (ISIs) of 5, 20 and 40ms. EMG in patients showed muscular hyperactivity at rest and reduced inhibition during straining. The BCR polysynaptic R2 had larger amplitude (p<0.01) and longer duration (p<0.01) in patients from both groups than in controls. In controls, paired-pulse SEPs were suppressed at the 5ms ISI for N35-P40 (p<0.05) and P40-N50 ms (p<0.001) and facilitated at the 20ms ISI for N35-P40 (p<0.05) and P40-N50 (p<0.05). No significant differences were found in the paired-pulse N35-P40 in patients and controls but the cortical P40-N50 at 20 ISI was facilitated in patients (p<0.05). EMG activity is enhanced and the cortical SEP recovery cycle and BCR are hyperexcitable in vaginismus. The neurophysiological abnormalities in patients with vaginismus indicate concomitant CNS changes in this disorder.

  9. Recommended standardized terminology of the anterior female pelvis based on a structured medical literature review.

    PubMed

    Jeppson, Peter C; Balgobin, Sunil; Washington, Blair B; Hill, Audra Jolyn; Lewicky-Gaupp, Christina; Wheeler, Thomas; Ridgeway, Beri; Mazloomdoost, Donna; Balk, Ethan M; Corton, Marlene M; DeLancey, John

    2018-07-01

    The use of imprecise and inaccurate terms leads to confusion amongst anatomists and medical professionals. We sought to create recommended standardized terminology to describe anatomic structures of the anterior female pelvis based on a structured review of published literature and selected text books. We searched MEDLINE from its inception until May 2, 2016, using 11 medical subject heading terms to identify studies reporting on anterior female pelvic anatomy; any study type published in English was accepted. Nine textbooks were also included. We screened 12,264 abstracts, identifying 200 eligible studies along with 13 textbook chapters from which we extracted all pertinent anatomic terms. In all, 67 unique structures in the anterior female pelvis were identified. A total of 59 of these have been previously recognized with accepted terms in Terminologia Anatomica, the international standard on anatomical terminology. We also identified and propose the adoption of 4 anatomic regional terms (lateral vaginal wall, pelvic sidewall, pelvic bones, and anterior compartment), and 2 structural terms not included in Terminologia Anatomica (vaginal sulcus and levator hiatus). In addition, we identified 2 controversial terms (pubourethral ligament and Grafenberg spot) that require additional research and consensus from the greater medical and scientific community prior to adoption or rejection of these terms. We propose standardized terminology that should be used when discussing anatomic structures in the anterior female pelvis to help improve communication among researchers, clinicians, and surgeons. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. A defect in early myogenesis causes Otitis media in two mouse models of 22q11.2 Deletion Syndrome

    PubMed Central

    Fuchs, Jennifer C.; Linden, Jennifer F.; Baldini, Antonio; Tucker, Abigail S.

    2015-01-01

    Otitis media (OM), the inflammation of the middle ear, is the most common disease and cause for surgery in infants worldwide. Chronic Otitis media with effusion (OME) often leads to conductive hearing loss and is a common feature of a number of craniofacial syndromes, such as 22q11.2 Deletion Syndrome (22q11.2DS). OM is more common in children because the more horizontal position of the Eustachian tube (ET) in infants limits or delays clearance of middle ear effusions. Some mouse models with OM have shown alterations in the morphology and angle of the ET. Here, we present a novel mechanism in which OM is caused not by a defect in the ET itself but in the muscles that control its function. Our results show that in two mouse models of 22q11.2DS (Df1/+ and Tbx1+/−) presenting with bi- or unilateral OME, the fourth pharyngeal arch-derived levator veli palatini muscles were hypoplastic, which was associated with an earlier altered pattern of MyoD expression. Importantly, in mice with unilateral OME, the side with the inflammation was associated with significantly smaller muscles than the contralateral unaffected ear. Functional tests examining ET patency confirmed a reduced clearing ability in the heterozygous mice. Our findings are also of clinical relevance as targeting hypoplastic muscles might present a novel preventative measure for reducing the high rates of OM in 22q11.2DS patients. PMID:25452432

  11. The structure and function of serially homologous leg motor neurons in the locust. I. Anatomy.

    PubMed

    Wilson, J A

    1979-01-01

    Twenty-one prothoracic and 17 mesothoracic motor neurons innervating leg muscles have been identified physiologically and subsequently injected with dye from a microelectrode. A tract containing the primary neurites of motor neurons innervating the retractor unquis, levator and depressor tarsus, flexor tibiae, and reductor femora is described. All motor neurons studied have regions in which their dendritic branches overlap with those of other leg motor neurons. Identified, serially homologous motor neurons in the three thoracic ganglia were found to have: (1) cell bodies at similar locations and morphologically similar primary neurites (e.g., flexor tibiae motor neurons), (2) cell bodies at different locations in each ganglion and morphologically different primary neurites in each ganglion (e.g., fast retractor unguis motor neurons), or (3) cell bodies at similar locations and morphologically similar primary neurites but with a functional switch in one ganglion relative to the function of the neurons in the other two ganglia. As an example of the latter, the morphology of the metathoracic slow extensor tibiae (SETi) motor neurons was similar to that of pro- and mesothoracic fast extensor tibiae (FETi) motor neurons. Similarly the metathoracic FETi bears a striking resemblance to the pro- and the mesothoracic SETi. It is proposed that in the metathoracic ganglion the two extensor tibiae motor neurons have switched functions while retaining similar morphologies relative to the structure and function of their pro- and mesothoracic serial homologues.

  12. Clinical anatomy of the pelvic floor.

    PubMed

    Fritsch, H; Lienemann, A; Brenner, E; Ludwikowski, B

    2004-01-01

    The study presented here comparing cross-sectional anatomy of the fetal and the adult pelvic connective tissue with the results of modern imaging techniques and actual surgical techniques shows that the classical concepts concerning the subdivision of the pelvic connective tissue and muscles need to be revised. According to clinical requirements, the subdivision of the pelvic cavity into anterior, posterior, and middle compartments is feasible. Predominating connecting tissue structures within the different compartments are: Paravisceral fat pad within the anterior compartment (Fig. 17, I), rectal adventitia or perirectal tissue within the posterior compartment (Fig. 17, II), and uterosacral ligaments within the middle compartment. The nerve-vessel guiding plate can be found in all of these compartments; it starts within the posterior compartment and it ends within the anterior one. It constitutes the morphological border between the anterior and posterior compartments in the male. This border is supplied by the uterosacral ligaments in the female. Whereas in gross anatomy no further border is discernable between anterior and posterior or middle compartment, the rectal fascia (hardly visible in embalmed cadavers) demarcates the rectal adventitia and is one of the most important pelvic structures for the surgeon. In principle, the outlined subdivision of the pelvic connective tissue is identical in the male and in the female; facts that become clear from early human life and that are already established during this period (Fig. 18). The uterus is interposed between the bladder and rectum and subdivides the pelvic peritoneum into two pouches thus establishing the only real difference between male and female pelvic cavity. The preferential direction of the pelvic connective tissue fibers is not changed by the interposition of the uterovaginal complex. The pelvic floor muscles are composed of the portions of the levator ani muscle, the muscles of the cavernous organs

  13. The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery.

    PubMed

    Tayebi Meybodi, Ali; Gandhi, Sirin; Preul, Mark C; Lawton, Michael T

    2018-04-27

    OBJECTIVE Exposure of the vertebral artery (VA) between C-1 and C-2 vertebrae (atlantoaxial VA) may be necessary in a variety of pathologies of the craniovertebral junction. Current methods to expose this segment of the VA entail sharp dissection of muscles close to the internal jugular vein and the spinal accessory nerve. The present study assesses the technique of exposing the atlantoaxial VA through a newly defined muscular triangle at the craniovertebral junction. METHODS Five cadaveric heads were prepared for surgical simulation in prone position, turned 30°-45° toward the side of exposure. The atlantoaxial VA was exposed through the subatlantic triangle after reflecting the sternocleidomastoid and splenius capitis muscles inferiorly. The subatlantic triangle was formed by 3 groups of muscles: 1) the levator scapulae and splenius cervicis muscles inferiorly and laterally, 2) the longissimus capitis muscle inferiorly and medially, and 3) the inferior oblique capitis superiorly. The lengths of the VA exposed through the triangle before and after unroofing the C-2 transverse foramen were measured. RESULTS The subatlantic triangle consistently provided access to the whole length of atlantoaxial VA. The average length of the VA exposed via the subatlantic triangle was 19.5 mm. This average increased to 31.5 mm after the VA was released at the C-2 transverse foramen. CONCLUSIONS The subatlantic triangle provides a simple and straightforward pathway to expose the atlantoaxial VA. The proposed method may be useful during posterior approaches to the craniovertebral junction should early exposure and control of the atlantoaxial VA become necessary.

  14. Optical stimulation of the facial nerve: a surgical tool?

    NASA Astrophysics Data System (ADS)

    Richter, Claus-Peter; Teudt, Ingo Ulrik; Nevel, Adam E.; Izzo, Agnella D.; Walsh, Joseph T., Jr.

    2008-02-01

    One sequela of skull base surgery is the iatrogenic damage to cranial nerves. Devices that stimulate nerves with electric current can assist in the nerve identification. Contemporary devices have two main limitations: (1) the physical contact of the stimulating electrode and (2) the spread of the current through the tissue. In contrast to electrical stimulation, pulsed infrared optical radiation can be used to safely and selectively stimulate neural tissue. Stimulation and screening of the nerve is possible without making physical contact. The gerbil facial nerve was irradiated with 250-μs-long pulses of 2.12 μm radiation delivered via a 600-μm-diameter optical fiber at a repetition rate of 2 Hz. Muscle action potentials were recorded with intradermal electrodes. Nerve samples were examined for possible tissue damage. Eight facial nerves were stimulated with radiant exposures between 0.71-1.77 J/cm2, resulting in compound muscle action potentials (CmAPs) that were simultaneously measured at the m. orbicularis oculi, m. levator nasolabialis, and m. orbicularis oris. Resulting CmAP amplitudes were 0.3-0.4 mV, 0.15-1.4 mV and 0.3-2.3 mV, respectively, depending on the radial location of the optical fiber and the radiant exposure. Individual nerve branches were also stimulated, resulting in CmAP amplitudes between 0.2 and 1.6 mV. Histology revealed tissue damage at radiant exposures of 2.2 J/cm2, but no apparent damage at radiant exposures of 2.0 J/cm2.

  15. The pathophysiology of pelvic floor disorders: evidence from a histomorphologic study of the perineum and a mouse model of rectal prolapse

    PubMed Central

    YIOU, RENÉ; DELMAS, VINCENT; CARMELIET, PETER; GHERARDI, ROMAIN K.; BARLOVATZ-MEIMON, GEORGIA; CHOPIN, DOMINIQUE K.; ABBOU, CLÉMENT-CLAUDE; LEFAUCHEUR, JEAN-PASCAL

    2001-01-01

    The muscle changes related to pelvic floor disorders are poorly understood. We conducted an anatomical and histological study of the perineum of the normal mouse and of a transgenic mouse strain deficient in urokinase-type plasminogen activator (uPA−/−) that was previously reported to develop a high incidence of rectal prolapse. We could clearly identify the iliococcygeus (ILC) and pubococcygeus (PC) muscles and anal (SPA) and urethral (SPU) sphincters in male and female mice. The bulbocavernosus (BC), ischiocavernosus (ISC) and levator ani (LA) muscles could be found only in male mice. Histochemical analysis of the pelvic floor muscles revealed a majority of type IIA fibres. Rectal prolapses were observed only in male uPA−/− mice. The most obvious finding was an irreducible evagination of the rectal mucosa and a swelling of the entire perineal region corresponding to an irreducible hernia of the seminal vesicles through the pelvic outlet. The hernia caused stretching and thinning of the ISC, BC and LA. Myopathic damage, with degenerated and centronucleated myofibres, were observed in these muscles. The PC, ILC, SPA and SPU were not affected. This study provides an original description of a model of pelvic floor disorder and illustrates the differences existing between the perineum of humans and that of a quadruped species. In spite of these differences, the histopathologic changes observed in the pelvic floor muscles of uPA−/− mice with rectal prolapse suggest that prolonged muscular stretching causes a primary myopathic injury. This should be taken into account in the evaluation of pelvic floor disorders. PMID:11760891

  16. The anatomy of the perineal body in relation to abdominoperineal excision for low rectal cancer.

    PubMed

    Kraima, A C; West, N P; Treanor, D; Magee, D; Roberts, N; van de Velde, C J H; DeRuiter, M C; Quirke, P; Rutten, H J T

    2016-07-01

    Dissection of the perineal body (PB) during abdominoperineal excision (APE) for low rectal cancer is often difficult due to the lack of a natural plane of dissection. Understanding the PB and its relation to the anorectum is essential to permit safe dissection during the perineal phase of the operation and avoid damage to the anorectum and urogenital organs. This study describes the anatomy and histology of the PB relevant to APE. Six human adult cadaver pelvic exenteration specimens (three male, three female) from the Leeds GIFT Research Tissue Programme were studied. Paraffin-embedded mega-blocks were produced and serially sectioned at 50- and 250-μm intervals. Sections were stained by immunohistochemistry to show collagen, elastin and smooth muscle. The PB was cylindrically shaped in the male specimens and wedge-shaped in the female ones. Although centrally located between the anal and urogenital triangles, it was nearly completely formed by muscle fibres derived from the rectal muscularis propria. Thick bundles of smooth muscle, mostly arising from the longitudinal muscle, inserted into the PB and levator ani muscle (LAM). The recto-urethralis muscle originated from the PB and separated the anterolateral PB from the urogenital organs. Smooth muscle fibres derived from the rectal muscularis propria extend into the PB and LAM and appear to fix the anorectum. Dissection of the PB during APE is safe only when the smooth muscle fibres that extend into the PB are divided. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  17. Soft tissue management of orbitotemporal neurofibromatosis.

    PubMed

    Singhal, Dhruv; Chen, Yi-Chieh; Chen, Yu-Ray; Chen, Philip Kuo-Ting; Tsai, Yueh-Ju

    2013-01-01

    The aim of this study was to provide an overview of a single-institution, 30-year surgical experience with the soft tissue management of orbitotemporal neurofibromatosis. Lessons learned are highlighted in case presentations. From 1981 to 2011, all patients who presented to the Chang Gung Memorial Hospital Craniofacial Center with craniofacial neurofibromatosis and orbitotemporal involvement were retrospectively reviewed. The medical records of those patients who underwent surgical correction were reviewed for age, extent of involvement, procedures performed, histologic confirmation, and acute complications. All patients were grouped according to the Jackson Classification. The electronic photobank was queried to evaluate results. Thirty-five patients presented to our center with orbitotemporal neurofibromatosis during the study period. Thirty-one patients underwent surgical management of their disease. The average age was 25 years (range 4 to 57 years). Over half of our patients (n = 18) presented with concomitant disease of the cheek. The 2 most common procedures performed were lateral canthopexy (n = 24) and upper eyelid excision (n = 24). The only acute complication recorded was a postoperative hematoma on the fourth postoperative day following simultaneous lateral canthopexy and upper eyelid excision which required operative evacuation. In orbitotemporal neurofibromatosis, tissue hyperextensibility and tumor weight adversely affect outcomes. Treatment of concomitant disease of the cheek should be prioritized in order to provide periorbital support prior to addressing the delicate structures of the eyelids. Preservation of the lateral canthal unit and levator muscle, despite neurofibroma infiltration, is critical to maximize outcomes following debulking procedures of the eyelid and orbit.

  18. Trigeminal Proprioception Evoked by Strong Stretching of the Mechanoreceptors in Müller's Muscle Induces Reflex Contraction of the Orbital Orbicularis Oculi Slow-Twitch Muscle Fibers.

    PubMed

    Matsuo, Kiyoshi; Ban, Ryokuya; Ban, Midori; Yuzuriha, Shunsuke

    2014-01-01

    The mixed orbicularis oculi muscle lacks an intramuscular proprioceptive system such as muscle spindles, to induce reflex contraction of its slow-twitch fibers. We evaluated whether the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction of the slow-twitch fibers of the orbicularis oculi in addition to those of the levator and frontalis muscles. We evaluated in patients with aponeurosis-disinserted blepharoptosis whether strong stretching of the mechanoreceptors in Müller's muscle from upgaze with unilateral lid load induced reflex contraction of the orbicularis oculi slow-twitch fibers and whether anesthesia of Müller's muscle precluded the contraction. We compared the electromyographic responses of the bilateral orbicularis oculi muscles to unilateral intraoperative direct stimulation of the trigeminal proprioceptive nerve with those to unilateral transcutaneous electrical stimulation of the supraorbital nerve. Upgaze with a unilateral 3-g lid load induced reflex contraction of the bilateral orbicularis oculi muscles with ipsilateral dominance. Anesthesia of Müller's muscle precluded the reflex contraction. The orbicularis oculi reflex evoked by stimulation of the trigeminal proprioceptive nerve differed from that by electrical stimulation of the supraorbital nerve in terms of the intensity of current required to induce the reflex, the absence of R1, and duration. The mechanoreceptors in Müller's muscle functions as an extramuscular proprioceptive system to induce reflex contraction of the orbital orbicularis oculi slow-twitch fibers. Whereas reflex contraction of the pretarsal orbicularis fast-twitch fibers functions in spontaneous or reflex blinking, that of the orbital orbicularis oculi slow-twitch fibers may factor in grimacing and blepharospasm.

  19. Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs.

    PubMed

    Stafford, Ryan E; Mazzone, Stuart; Ashton-Miller, James A; Constantinou, Christos; Hodges, Paul W

    2014-04-15

    Coughing provokes stress urinary incontinence, and voluntary coughs are employed clinically to assess pelvic floor dysfunction. Understanding urethral dynamics during coughing in men is limited, and it is unclear whether voluntary coughs are an appropriate surrogate for spontaneous coughs. We aimed to investigate the dynamics of urethral motion in continent men during voluntary and evoked coughs. Thirteen men (28-42 years) with no history of urological disorders volunteered to participate. Transperineal ultrasound (US) images were recorded and synchronized with measures of intraabdominal pressure (IAP), airflow, and abdominal/chest wall electromyography during voluntary coughs and coughs evoked by inhalation of nebulized capsaicin. Temporal and spatial aspects of urethral movement induced by contraction of the striated urethral sphincter (SUS), levator ani (LA), and bulbocavernosus (BC) muscles and mechanical aspects of cough generation were investigated. Results showed coughing involved complex urethral dynamics. Urethral motion implied SUS and BC shortening and LA lengthening during preparatory and expulsion phases. Evoked coughs resulted in greater IAP, greater bladder base descent (LA lengthening), and greater midurethral displacement (SUS shortening). The preparatory inspiration cough phase was shorter during evoked coughs, as was the latency between onset of midurethral displacement and expulsion. Maximum midurethral displacement coincided with maximal bladder base descent during voluntary cough, but followed it during evoked cough. The data revealed complex interaction between muscles involved in continence in men. Spatial and temporal differences in urethral dynamics and cough mechanics between cough types suggest that voluntary coughing may not adequately assess capacity of the continence mechanism.

  20. Multi-scale finite element modeling of Eustachian tube function: influence of mucosal adhesion.

    PubMed

    Malik, J E; Swarts, J D; Ghadiali, S N

    2016-12-01

    The inability to open the collapsible Eustachian tube (ET) leads to the development of chronic Otitis Media (OM). Although mucosal inflammation during OM leads to increased mucin gene expression and elevated adhesion forces within the ET lumen, it is not known how changes in mucosal adhesion alter the biomechanical mechanisms of ET function. In this study, we developed a novel multi-scale finite element model of ET function in adults that utilizes adhesion spring elements to simulate changes in mucosal adhesion. Models were created for six adult subjects, and dynamic patterns in muscle contraction were used to simulate the wave-like opening of the ET that occurs during swallowing. Results indicate that ET opening is highly sensitive to the level of mucosal adhesion and that exceeding a critical value of adhesion leads to rapid ET dysfunction. Parameter variation studies and sensitivity analysis indicate that increased mucosal adhesion alters the relative importance of several tissue biomechanical properties. For example, increases in mucosal adhesion reduced the sensitivity of ET function to tensor veli palatini muscle forces but did not alter the insensitivity of ET function to levator veli palatini muscle forces. Interestingly, although changes in cartilage stiffness did not significantly influence ET opening under low adhesion conditions, ET opening was highly sensitive to changes in cartilage stiffness under high adhesion conditions. Therefore, our multi-scale computational models indicate that changes in mucosal adhesion as would occur during inflammatory OM alter the biomechanical mechanisms of ET function. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  1. Efficacy of hypopressive abdominal gymnastics in rehabilitating the pelvic floor of women: A systematic review.

    PubMed

    Ruiz de Viñaspre Hernández, R

    2017-12-13

    Hypopressive abdominal gymnastics has been proposed as a new paradigm in rehabilitating the pelvic floor. Its claims contraindicate the recommendation for pelvic floor muscle training during the postpartum period. To determine whether hypopressive abdominal gymnastics is more effective than pelvic floor muscle training or other alternative conservative treatments for rehabilitating the pelvic floor. We consulted the databases of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Latin American and Caribbean Health Sciences Literature (LILACS), Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Trip Database and Web of Science. We selected systematic reviews, clinical trials and analytical studies that assessed the efficacy of hypopressive abdominal gymnastics in women. The measured outcomes were the strengthening of the pelvic floor muscles, the incidence of urine incontinence or prolapse and symptom remission. We included 4 clinical trials, whose quality was measured with the PEDro scale. Hypopressive gymnastics is less effective than pelvic floor muscle training for activating pelvic floor muscles, achieving closure of the levator hiatus of the anus and increasing pelvic floor muscle thickness, strength and resistance. The evidence reviewed does not support the recommendation for hypopressive abdominal gymnastics for strengthening the pelvic floor either during the postpartum period or outside that period. Pelvic floor muscle training remains the first-line treatment for pelvic floor dysfunction. There is a lack of quality clinical trials that have evaluated the efficacy of hypopressive abdominal gymnastics. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Facial Contouring by Targeted Restoration of Facial Fat Compartment Volume: The Midface.

    PubMed

    Wang, Wenjin; Xie, Yun; Huang, Ru-Lin; Zhou, Jia; Tanja, Herrler; Zhao, Peijuan; Cheng, Chen; Zhou, Sizheng; Pu, Lee L Q; Li, Qingfeng

    2017-03-01

    Recent anatomical findings have suggested that facial fat distribution is complex and changes with age. Here, the authors developed a grafting technique based on the physiologic distribution and volume changes of facial fat compartments to achieve a youthful and natural-appearing face. Forty cadaveric hemifaces were used for the dissection of fat compartments and neurovascular structures in the midface area. Seventy-eight patients were treated for cheek atrophy using the authors' targeted restoration of midface fat compartment volume. The outcome was evaluated by a two-dimensional assessment, malar lipoatrophy assessment, and a satisfaction survey. The medial and lateral parts of the deep medial cheek fat compartment were separated by a septum arising from the lateral border of the levator anguli oris muscle. The angular vein traveled between the deep medial cheek fat compartment and the buccal fat pad, 12 mm from the maxilla. A total volume of 29.3 ml of fat was grafted per cheek for each patient. A 12-month follow-up revealed an average volume augmentation rate of 27.1 percent. Pleasing and elevated anterior projection of the cheek and ameliorated nasolabial groove were still obvious by 12 months after the procedure. In total, 95.2 percent of the patients were satisfied with their results. The present study provides the anatomical and clinical basis for the concept of compartmentally based fat grafting. It allows for the restoration of facial fat volume close to the physiologic state. With this procedure, a natural and youthful facial contour could be rebuilt with a high satisfaction rate. Therapeutic, IV.

  3. Oculopalatal tremor, facial myokymia and truncal ataxia in a patient with neurosarcoidosis.

    PubMed

    Sidiropoulos, Christos; Sripathi, Naganand; Nasrallah, Khalil; Mitsias, Panayiotis

    2014-12-01

    Symptomatic palatal tremor (SPT) is the result of a structural lesion, in the form of stroke, trauma or demyelinating disease. SPT is due to contractions of the levator veli palatini and can be accompanied by simultaneous movements of the facial and ocular muscles. Facial myokymia (FM) is a persistent quivering of the facial muscles. FM is usually encountered with conditions involving the pontine tegmentum. We report, to our knowledge, the first patient with neurosarcoidosis with simultaneous SPT and FM. A 49-year-old African American woman, with non-caseating granulomas in a paratracheal lymph node biopsy, presented with progressive gait disturbances for the last 3 years. Neurological examination revealed ataxic speech, bilateral rotatory nystagmus, myokymia of the chin and perioral muscles, palatal tremor without ear click and marked truncal ataxia. MRI demonstrated a lesion involving the facial nucleus and the right middle cerebellar peduncle. Based on exclusion of alternative etiologies, a diagnosis of neurosarcoidosis was made and the patient was started on methotrexate for 9 months, with minimal improvement. She was then switched to intravenous infliximab without major adverse events. The patient's speech and gait ataxia improved and follow up MRI demonstrated resolution of the enhancing lesions. To our knowledge, this is the first reported case of the combination of palatal tremor and FM due to neurosarcoidosis. Methotrexate may fail to produce clinical or radiographic response in up to 39% of patients. Tumor necrosis factor-α inhibitors, such as infliximab, should be considered in refractory cases. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Inhibition of in vitro and in vivo brown fat differentiation program by myostatin.

    PubMed

    Braga, Melissa; Pervin, Shehla; Norris, Keith; Bhasin, Shalender; Singh, Rajan

    2013-06-01

    Obesity arises mainly due to the imbalance between energy storage and its expenditure. Metabolically active brown adipose tissue (BAT) has recently been detected in humans and has been proposed as a new target for anti-obesity therapy because of its unique capacity to regulate energy expenditure. Myostatin (Mst), a negative regulator of muscle mass, has been identified as a potential target to regulate overall body composition. Although the beneficial effects of Mst inhibition on muscle mass are well known, its role in the regulation of lipid metabolism, and energy expenditure is not very clear. We tested the effects of Mst inhibition on the gene regulatory networks that control BAT differentiation using both in vivo and in vitro model systems. PRDM16 and UCP1, two key regulators of brown fat differentiation were significantly up regulated in levator-ani (LA) and gastrocnemius (Gastroc) muscles as well as in epididymal (Epi) and subcutaneous (SC) fat pads isolated from Mst knock out (Mst KO) male mice compared with wild type (WT) mice. Using mouse embryonic fibroblast (MEFs) primary cultures obtained from Mst KO group compared to the WT group undergoing adipogenic differentiation, we also demonstrate a significant increase in select genes and proteins that improve lipid metabolism and energy expenditure. Treatment of Mst KO MEFs with recombinant Mst protein significantly inhibited the gene expression levels of UCP1, PRDM16, PGC1-α/β as well as BMP7. Future studies to extend these findings and explore the therapeutic potential of Mst inhibition on metabolic disorders are warranted. Copyright © 2012 The Obesity Society.

  5. Movement System Impairment-Guided Approach to the Physical Therapist Treatment of a Patient With Postpartum Pelvic Organ Prolapse and Mixed Urinary Incontinence: Case Report.

    PubMed

    Kurz, Jenny; Borello-France, Diane

    2017-04-01

    Women with postpartum pelvic organ prolapse (POP) and urinary incontinence are often treated by physical therapists specializing in women's health. Movement system impairments often coexist in this patient population. The purpose of this case report is to describe the physical therapist treatment of a woman with postpartum POP complicated by additional pelvic symptoms. A 31-year-old woman presented with postpartum POP, diastasis recti, urinary incontinence, and constipation. Movement system impairments were consistent with a physical therapist diagnosis of femoral adduction-medial rotation syndrome exacerbated by levator ani muscle weakness and incoordination and impaired intra-abdominal pressure regulation. Interventions, based on a movement system guided approach, included postural correction; pelvic-floor, abdominal, and hip muscle strengthening; functional training to correct identified movement faults; and patient education. Movement system impairment outcomes included: correction of femoral adduction-medial rotation and knee hyperextension during standing at rest, ambulation, and exercise; increased hip muscle strength; and effective regulation of intra-abdominal pressure (resolution of breath holding with the Valsalva maneuver) during all transitional movements and therapeutic exercise. The patient also demonstrated reductions in POP, urinary, and colorectal symptom severity that exceeded the minimal clinically important difference. Additionally, she demonstrated a reduction in diastasis rectus distance. A movement system impairment-guided approach led the physical therapist to consider impairments outside the pelvic floor that could have contributed to the patient's pelvic symptoms. Using this approach, the patient achieved resolution of musculoskeletal and movement impairments and reductions in POP, urinary and colorectal symptoms, and symptom-related distress. © 2016 American Physical Therapy Association

  6. Study of the pelvic floor muscles in vaginismus: a concept of pathogenesis.

    PubMed

    Shafik, Ahmed; El-Sibai, Olfat

    2002-10-10

    Neither the cause of vaginismus nor the muscles involved are precisely identified. To define the involved muscles and their role in the pathogenesis of vaginismus. The EMG activity of the levator ani (LA), puborectalis (PR) and bulbocavernosus (BC) muscles was studied in seven female patients (age (years): 25.6(mean)+/-1.2(S.D.)) and seven healthy volunteers who matched the patients in age. Recordings were performed at rest and during induction of vaginismus by a vaginal dilator. Upon approximating the vaginal dilator to the vaginal introitus or introducing it into the vagina of the healthy volunteers, the EMG activity of the LA, PR and BC muscles showed no significant difference from the basal activity. In the patients, the basal EMG activity of the examined muscles was significantly higher than that of the healthy volunteers (P<0.05). Upon vaginismus induction, the muscles showed a significant increase of the EMG activity (P<0.01). The latency recorded a mean of 14.2+/-2.3, 13.9+/-2.3 and 14.1+/-2.2ms (P>0.05) in the LA, PR and BC muscles, respectively. The muscle response was momentary lasting a mean of 31.2+/-5.7s. It was reproducible provided an off-time of a mean of 13.2+/-2.3s was observed. The pelvic floor muscles of vaginismus patients exhibited increased EMG activity at rest and on vaginismus induction; the cause is unknown. The concept of a disordered sacral reflex arc is put forward but needs further studies to be verified.

  7. Downlink Probability Density Functions for EOS-McMurdo Sound

    NASA Technical Reports Server (NTRS)

    Christopher, P.; Jackson, A. H.

    1996-01-01

    The visibility times and communication link dynamics for the Earth Observations Satellite (EOS)-McMurdo Sound direct downlinks have been studied. The 16 day EOS periodicity may be shown with the Goddard Trajectory Determination System (GTDS) and the entire 16 day period should be simulated for representative link statistics. We desire many attributes of the downlink, however, and a faster orbital determination method is desirable. We use the method of osculating elements for speed and accuracy in simulating the EOS orbit. The accuracy of the method of osculating elements is demonstrated by closely reproducing the observed 16 day Landsat periodicity. An autocorrelation function method is used to show the correlation spike at 16 days. The entire 16 day record of passes over McMurdo Sound is then used to generate statistics for innage time, outage time, elevation angle, antenna angle rates, and propagation loss. The levation angle probability density function is compared with 1967 analytic approximation which has been used for medium to high altitude satellites. One practical result of this comparison is seen to be the rare occurrence of zenith passes. The new result is functionally different than the earlier result, with a heavy emphasis on low elevation angles. EOS is one of a large class of sun synchronous satellites which may be downlinked to McMurdo Sound. We examine delay statistics for an entire group of sun synchronous satellites ranging from 400 km to 1000 km altitude. Outage probability density function results are presented three dimensionally.

  8. Prevalence and elimination of sibling neurite convergence in motor units supplying neonatal and adult mouse skeletal muscle.

    PubMed

    Teriakidis, Adrianna; Willshaw, David J; Ribchester, Richard R

    2012-10-01

    During development, neurons form supernumerary synapses, most of which are selectively pruned leading to stereotyped patterns of innervation. During the development of skeletal muscle innervation, or its regeneration after nerve injury, each muscle fiber is transiently innervated by multiple motor axon branches but eventually by a single branch. The selective elimination of all but one branch is the result of competition between the converging arbors. It is thought that motor neurons initially innervate muscle fibers randomly, but that axon branches from the same neuron (sibling branches) do not converge to innervate the same muscle fiber. However, random innervation would result in many neonatal endplates that are co-innervated by sibling branches. To investigate whether this occurs we examined neonatal levator auris longus (LAL) and 4th deep lumbrical (4DL) muscles, as well as adult reinnervated deep lumbrical muscles (1-4) in transgenic mice expressing yellow fluorescent protein (YFP) as a reporter. We provide direct evidence of convergence of sibling neurites within single fluorescent motor units, both during development and during regeneration after nerve crush. The incidence of sibling neurite convergence was 40% lower in regeneration and at least 75% lower during development than expected by chance. Therefore, there must be a mechanism that decreases the probability of its occurrence. As sibling neurite convergence is not seen in normal adults, or at later timepoints in regeneration, synapse elimination must also remove convergent synaptic inputs derived from the same motor neuron. Mechanistic theories of synaptic competition should now accommodate this form of isoaxonal plasticity. Copyright © 2012 Wiley Periodicals, Inc.

  9. The effect of age at surgery and compensatory articulation on speech outcome in submucous cleft palate patients treated with double-opposing Z-plasty: A 10-year experience.

    PubMed

    Baek, Rong-Min; Kim, Baek-Kyu; Jeong, Jae Hoon; Ahn, Taeseon; Park, Mikyong; Han, Jihyeon

    2017-05-01

    Submucous cleft palate is a congenital deformity that may present as velopharyngeal insufficiency. The degree of anatomical abnormality varies widely among patients and does not predict severity of symptom. We present our 10-year experience treating submucous cleft palate patients with double opposing z-plasty and explore the effect of age at surgery and compensatory articulation on speech. Preoperative assessment included intraoral examination, nasoendoscopy, and perceptual speech evaluation. Age, gap size, and severity of hypernasality were assessed to determine the timing and type of surgery. A retrospective study of 74 submucous cleft palate patients undergoing double-opposing z-plasty from 2005 to 2016 by a single surgeon (Baek RM) was conducted. Double opposing z-plasty was modified to fully release all abnormal insertions of the levator veli palatini muscle. Postoperative velopharyngeal function was measured and statistical analyses were performed. The ages of patients at surgery ranged from 11 months to 19 years. Postoperatively 87 percent of the patients achieved velopharyngeal competency and 13 percent had remaining mild hypernasality. Age was a significant factor in predicting speech outcome, and patients receiving surgery prior to the age of 5.5 years had a higher normalization rate. Compensatory articulation did not have an impact on postoperative hypernasality. There were no cases of postoperative hyponasality or airway problems. Satisfactory speech outcome was achieved with the authors' protocol and modification of the double-opposing z-plasty. A comprehensive assessment of patient age, intraoral findings, severity of hypernasality, and gap size, is necessary for proper treatment of submucous cleft palate patients. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  10. Pediatric ptosis as a sign of treatable autonomic dysfunction.

    PubMed

    Phillips, Lara; Robertson, David; Melson, Mark R; Garland, Emily M; Joos, Karen M

    2013-08-01

    To report the ophthalmic findings in young patients with dopamine β-hydroxylase deficiency and to assess them in the context of other reports in an attempt to discern if ophthalmic criteria may assist in early detection of this debilitating, yet treatable, disorder. Prospective, observational case series. An ophthalmic examination, including measuring intraocular and systemic blood pressures while supine, sitting, and standing, and eyelid function and pupillary function testing, was completed on 3 young patients with recently documented dopamine β-hydroxylase deficiency at a single institution. Mean arterial blood pressures were 90.1 ± 18.5 mm Hg supine, 79.1 ± 25.7 mm Hg sitting, and 45.8 ± 11.6 mm Hg standing (P = .021). Mean intraocular pressures in these patients were 15.8 ± 1.0 mm Hg supine, 15.0 ± 3.6 mm Hg sitting, and 7.7 ± 2.3 mm Hg standing (P = .03). Mean palpebral fissure, levator function, and margin reflex distance were 8.2 ± 1.0 mm, 16.0 ± 0 mm, and 2.8 ± 0.6 mm, respectively. Measurable miosis was present in only 1 patient, and pupillary supersensitivity to 2.5% phenylephrine was not observed. The ophthalmologic findings of the patients in this case series documented mild ptosis and striking orthostatic reductions in intraocular pressure and mean arterial blood pressure, as might be expected with a lack of intrinsic sympathetic function. Orthostatic intraocular pressure and mean arterial blood pressure may be a helpful early screening tool for autonomic dysfunction in children undergoing a ptosis evaluation. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. The Palatal Interpterygoid Vacuities of Temnospondyls and the Implications for the Associated Eye- and Jaw Musculature.

    PubMed

    Witzmann, Florian; Werneburg, Ingmar

    2017-07-01

    A diagnostic feature of temnospondyls is the presence of an open palate with large interpterygoid vacuities, unlike the closed palate of most other early tetrapods, in which the vacuities are either slit-like or completely absent. Attachment sites on neurocranium and palatal bones in temnospondyls allow the reconstruction of a powerful m. retractor bulbi and a large, sheet-like m. levator bulbi that formed the elastic floor of the orbit. This muscle arrangement indicates that temnospondyls were able to retract the eyeballs through the interpterygoid vacuities into the buccal cavity, like extant frogs and salamanders. In contrast, attachment sites on palate and neurocranium suggest a rather sauropsid-like arrangement of these muscles in stem-tetrapods and stem-amniotes. However, the anteriorly enlarged, huge interpterygoid vacuities of long-snouted stereospondyls suggest that eye retraction was not the only function of the vacuities here, since the eye-muscles filled only the posterior part of the vacuities. We propose an association of the vacuities in temnospondyls with a long, preorbital part of the m. adductor mandibulae internus (AMIa). The trochlea-like, anterior edge of the adductor chamber suggests that a tendon of the AMIa was redirected in an anteromedial direction in the preorbital skull and dorsal to the pterygoids. This tendon then unfolded into a wide aponeurosis bearing the flattened AMIa that filled almost the complete interpterygoid vacuities anterior to the orbits. Our muscle reconstructions permit comprehensive insights to the comparative soft tissue anatomy of early tetrapods and provide the basis for a biomechanic analysis of biting performances in the future. Anat Rec, 300:1240-1269, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  12. Biofeedback defaecation training for anismus.

    PubMed

    Lestàr, B; Penninckx, F; Kerremans, R

    1991-11-01

    Anismus, paradoxical external sphincter function, spastic pelvic floor syndrome, rectoanal dysnergia, abdomino-levator incoordination for abdominopelvic asychronism, are all due to paradoxical contraction of the striated sphincter apparatus during voiding and is characterised by prolonged and excessive straining at stool. Biofeedback is the treatment of choice and has to be introduced at an early stage. We present the results of an ambulatory approach based on the integration of simulated balloon defaecation with small (50 ml) as well as constant rectal sensation volume, defaecometry and anal manometry. The pathophysiology visualised by the patient's own anorectal pressure recordings on the screen of a personal computer is explained and corrected. Sixteen patients were treated and followed for at least 1 year. Manometric data were normal except for an increased minimum residual pressure and rectal compliance. Nine patients could not evacuate a 50 ml bolus initially. Simulated defaecation became possible in seven out of these nine patients when the bolus was increased up to the individual constant rectal sensation volume. Two patients could not evacuate this volume either, while defaecation was made much less laborious in the other seven patients. Paradoxical contraction was immediately corrected in 7/16 cases. Also, as an immediate, objective benefit of a single training session, improved defaecation of a 50 ml bolus was observed in 11 patients. This effect was preserved after 6 weeks in nine cases; symptomatic recurrence did not occur in these patients during follow-up. This method of defaecation training has many advantages as compared with sphincter training using EMG electrodes eventually performed in the absence of a desire to defaecate or in lying position.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Clinical application of the right sidelying respiratory left adductor pull back exercise.

    PubMed

    Boyle, Kyndall L

    2013-06-01

    Lumbopelvic-femoral conditions are common and may be associated with asymmetrical musculoskeletal and respiratory impairments and postural mal-alignment called a Left Anterior Interior Chain (AIC) pattern. An inherent pattern of asymmetry involves the trunk/ribs/spine/pelvis/hip joints and includes the tendency to stand on the right leg and shift the center of gravity to the right which may result for example, in a tight left posterior hip capsule, poorly approximated left hip, long/weak left adductors, internal obliques (IO) and transverse abdominus (TA), short/strong/over active paraspinals and muscles on the right anterior outlet (adductors, levator ani and obturator internus), a left rib flare and a decreased respiratory diaphragm zone of apposition (ZOA). A therapeutic exercise technique that can address impairments associated with postural asymmetry may be beneficial in improving function, reducing and/or eliminating pain causation, and improving breathing. The Right Sidelying Left Respiratory Adductor Pull Back is an exercise designed to affect alignment of the lumbopelvic-femoral region by influencing the left posterior ischiofemoral ligament, ZOA and right anterior outlet and left anterior inlet (rectus femoris, sartorius), activating/shortening the left adductors, left IO/TA's and inhibiting/lengthening the paraspinals, bilaterally. The exercise technique is often used by Physical Therapists, Physical Therapist assistants and Athletic Trainers as an initial exercise to positively affect position/alignment of the lumbopelvic-femoral region, referred to as "repositioning," by clinicians who use it. Four published case studies have used similar exercises to address the above impairments associated with a Left AIC pattern and in each 100% improvement in function and pain intensity was described. This particular exercise technique is relatively new and warrants future research.

  14. Trigeminal Proprioception Evoked by Strong Stretching of the Mechanoreceptors in Müller's Muscle Induces Reflex Contraction of the Orbital Orbicularis Oculi Slow-Twitch Muscle Fibers

    PubMed Central

    Ban, Ryokuya; Ban, Midori; Yuzuriha, Shunsuke

    2014-01-01

    Objective: The mixed orbicularis oculi muscle lacks an intramuscular proprioceptive system such as muscle spindles, to induce reflex contraction of its slow-twitch fibers. We evaluated whether the mechanoreceptors in Müller's muscle function as extrinsic mechanoreceptors to induce reflex contraction of the slow-twitch fibers of the orbicularis oculi in addition to those of the levator and frontalis muscles. Methods: We evaluated in patients with aponeurosis-disinserted blepharoptosis whether strong stretching of the mechanoreceptors in Müller's muscle from upgaze with unilateral lid load induced reflex contraction of the orbicularis oculi slow-twitch fibers and whether anesthesia of Müller's muscle precluded the contraction. We compared the electromyographic responses of the bilateral orbicularis oculi muscles to unilateral intraoperative direct stimulation of the trigeminal proprioceptive nerve with those to unilateral transcutaneous electrical stimulation of the supraorbital nerve. Results: Upgaze with a unilateral 3-g lid load induced reflex contraction of the bilateral orbicularis oculi muscles with ipsilateral dominance. Anesthesia of Müller's muscle precluded the reflex contraction. The orbicularis oculi reflex evoked by stimulation of the trigeminal proprioceptive nerve differed from that by electrical stimulation of the supraorbital nerve in terms of the intensity of current required to induce the reflex, the absence of R1, and duration. Conclusions: The mechanoreceptors in Müller's muscle functions as an extramuscular proprioceptive system to induce reflex contraction of the orbital orbicularis oculi slow-twitch fibers. Whereas reflex contraction of the pretarsal orbicularis fast-twitch fibers functions in spontaneous or reflex blinking, that of the orbital orbicularis oculi slow-twitch fibers may factor in grimacing and blepharospasm. PMID:25210572

  15. Biomechanical Analyses of the Efficacy of Patterns of Maternal Effort on Second-Stage Progress

    PubMed Central

    Lien, Kuo-Cheng; DeLancey, John O.L.; Ashton-Miller, James A.

    2009-01-01

    OBJECTIVE To develop and use a biomechanical computer model to simulate the effect of varying the timing of voluntary maternal pushes during uterine contraction on second-stage labor duration. METHODS Published initial pelvic floor geometry was imported into technical computing software to build a simplified 3-D biomechanical model with six representative viscoelastic levator muscle bands interconnected by a hyperelastic iliococcygeal raphé. An incompressible sphere simulated the molded fetal head. Forces from uterine contraction and voluntary expulsive efforts were summed to push the model fetal head along the Curve of Carus opposed by the resistance of the pelvic floor structures to stretch. Holding uterine maximal contraction force and push strength constant, pushes were timed before (“Pre”), at (“Peak”), and after (“Post”) maximal uterine contraction force. The effect of different combinations of pushes on second stage duration and the number of pushes required for delivery were evaluated. RESULTS Calculated second stage durations ranged from 57.5 minutes (“triple” or Pre-Peak-Post pattern) to 75.8 minutes (“pre-push” and “post-push” patterns). Delivery with the “triple push” pattern required 59 voluntary pushes, while the “peak push” pattern required 23 voluntary pushes, a 61% reduction. The corresponding reduction for the “pre-and-peak push” pattern was 29%, the “peak-and-post push” pattern was 30%, the “pre-push” pattern was 54%, and the “post-push” pattern was 56%. CONCLUSION Although the “triple push” pattern resulted in a 16% shorter second stage, this came at the energetic expense of a 61% increase in the number of pushes required. PMID:19305333

  16. Quantitative Anatomy of the Trapezius Muscle in the Human Fetus.

    PubMed

    Badura, Mateusz; Grzonkowska, Magdalena; Baumgart, Mariusz; Szpinda, Michał

    2016-01-01

    The trapezius muscle consists of three parts that are capable of functioning independently. Its superior part together with the levator scapulae and rhomboids elevate the shoulder, the middle part retracts the scapula, while the inferior part lowers the shoulder. The present study aimed to supplement numerical data and to provide growth dynamics of the trapezius in the human fetus. Using methods of anatomical dissection, digital image analysis (NIS Elements AR 3.0), and statistics (Student's t-test, regression analysis), we measured the length, the width and the surface area of the trapezius in 30 fetuses of both sexes (13™ k,17™ … ) aged 13-19 weeks. Neither sex nor laterality differences were found. All the studied parameters of the trapezius increased proportionately with age. The linear functions were computed as follows: y = -103.288 + 10.514 × age (r = 0.957) for total length of the trapezius muscle, y = -67.439 + 6.689 × age (r = 0.856) for length of its descending part, y = -8.493 + 1.033 × age (r = 0.53) for length of its transverse part, y = -27.545 + 2.802 × age (r = 0.791) for length of its ascending part, y = -19.970 + 2.505 × age (r = 0.875) for width of the trapezius muscle, and y = -2670.458 + 212.029 × age (r = 0.915) for its surface area. Neither sex nor laterality differences exist in the numerical data of the trapezius muscle in the human fetus. The descending part of trapezius is the longest, while its transverse part is the shortest. The growth dynamics of the fetal trapezius muscle follows proportionately.

  17. OECD validation of the Hershberger assay in Japan: phase 2 dose response of methyltestosterone, vinclozolin, and p,p'-DDE.

    PubMed

    Yamasaki, Kanji; Sawaki, Masakuni; Ohta, Ryo; Okuda, Hirokazu; Katayama, Seiichi; Yamada, Tomoya; Ohta, Takafumi; Kosaka, Tadashi; Owens, William

    2003-12-01

    The Organisation for Economic Co-operation and Development has initiated the development of new guidelines for the screening and testing of potential endocrine disruptors. The Hershberger assay is one of the assays selected for validation based on the need for in vivo screening to detect androgen agonists or antagonists by measuring the response of five sex accessory organs and tissues of castrated juvenile male rats: the ventral prostate, the seminal vesicles with coagulating glands, the levator ani and bulbocavernosus muscle complex, the Cowper's glands, and the glans penis. The phase 1 feasibility demonstration stage of the Hershberger validation program has been successfully completed with a single androgen agonist and a single antagonist as reference substances. The phase 2 validation program employs a range of additional androgen agonists and antagonists as well as 5alpha-reductase inhibitors. Seven Japanese laboratories have contributed phase 2 validation studies of the Hershberger assay using methyltestosterone, vinclozolin, and 2,2-bis (4-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE). The methyltestosterone doses were 0, 0.05, 0.5, 5, and 50 mg/kg/day, and the vinclozolin and p,p'-DDE doses were 0, 3, 10, 30, and 100 mg/kg/day. All chemicals were orally administered by gavage for 10 consecutive days. In the antagonist version of the assay using vinclozolin and p,p'-DDE, 0.2 mg/kg/day of testosterone propionate was coadministered by subcutaneous injection. All five accessory sex preproductive organs and tissues consistently responded with statistically significant changes in weight within a narrow window. Therefore, the Japanese studies support the Hershberger assay as a reliable and reproducible screening assay for the detection of androgen agonistic and antagonistic effects.

  18. Pelvic organ support several years after a first birth.

    PubMed

    Ferreira, Caroline W S; Atan, Ixora K; Martin, Andrew; Shek, Ka Lai; Dietz, Hans Peter

    2017-10-01

    Female pelvic organ prolapse is highly prevalent and childbirth has been shown to be an important risk factor. The study was carried out to observe if pelvic organ support deteriorates over time following a first birth. This is a retrospective review using archived data sets of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone a standardised interview, a clinical examination and 4D translabial ultrasound, 3 months and 2-5 years post-partum. Main outcome measures were pelvic organ descent and hiatal area at maximum Valsalva manoeuvre. Means at the two time points were compared using paired Student's t test. Predictors of change over time in continuous variables were explored using linear modelling methods. A total of 300 women had at least two postnatal follow-ups. They were first seen on average 0.39 (SD 0.2, range 0.2-2.1) years and again 3.1 (SD 1.5, range 1.4-8) years after the index delivery, with a mean interval of 2.71 (SD 1.5, range 0.7-7.7) years, providing a total of 813 (300 × 2.71) woman-years of observation. On univariate analysis, there was a significant decrease in mobility over time of the bladder neck, bladder, and rectal ampulla (P = < 0.004) and hiatal area (P = 0.012). The degree of improvement was less marked in women with levator avulsion. A significant reduction in pelvic organ descent and hiatal area was noted over a mean of 2.7 years after a first birth.

  19. Complex perirectal sepsis: clinical classification and imaging.

    PubMed

    Zbar, A P; Armitage, N C

    2006-07-01

    The use of specialized imaging to assess cryptogenic fistula-in-ano is selective, aimed at delineation of the site of the internal fistula opening and the relationship of the primary and secondary tracks and collections to the main levator plate. Advanced imaging also permits definition of the destructive effects of perirectal sepsis (e.g. internal or external anal sphincter damage, perineal body destruction and an ano- or rectovaginal fistula), which may require secondary reconstructive surgery. We performed a PubMed search of outcomes for fistula management in the English and non-English literature, and summarized results regarding the accuracy of internal opening and horseshoe detection as well as the operative correlation for cryptogenic and non-cryptogenic fistula-in-ano using endoanal ultrasound (EAUS) and magnetic resonance (MR) imaging. Only literature defining these characteristics was included. The advantages and limitations of the main forms of imaging are discussed in this review with emphasis on EAUS and endoanal or pelvic phased-array MR fistulography. The new technique of transperineal sonography is highlighted. A small but important group of patients with complex fistula-in-ano require specialized imaging. There are specific limitations of endoanal ultrasound (EAUS) which necessitate pelvic phased-array MR imaging. Initial work suggests that EAUS may have a role in intraoperative use for image-guided drainage of recurrent abscesses where operative interpretation can be difficult. The coloproctologist in a tertiary referral center must acquire the skills of ultrasound performance in order to successfully treat fistulous disease, suggesting a role for formal imaging accreditation as part of coloproctological training. Future studies should determine both what sequential imaging algorithms for imaging are cost-effective as well as predictive of fistula cure.

  20. Effect of double-fold surgery on spontaneous resolution of Graves' upper eyelid retraction.

    PubMed

    Kim, Dong Kyu; Choi, Moonjung; Yoon, Jin Sook

    2015-02-01

    To investigate the effect of previous incisional double-fold surgery on spontaneous resolution of eyelid retraction caused by Graves orbitopathy (GO) in Asian individuals. Retrospective review of medical records. Patients (N = 30; 39 eyes) with eyelid retraction associated with GO with symptom duration of less than 6 months. Patients who visited the Ophthalmology Department of Severance Hospital, Yonsei University, between January 2010 and December 2011, followed up for more than 6 months and in a euthyroid state with antithyroid drug treatment were included. Patients treated with steroids or who underwent surgery during follow-up were excluded. Upper scleral show was measured as the distance between the central upper lid margin and limbus at initial presentation and after 6 months. Comparative analysis was performed between the 2 groups delineated by history (n = 12; 16 eyes), or lack thereof (n = 18; 23 eyes), of incisional double-fold surgery before onset of GO symptoms and signs. Patient demographics and initial upper scleral show were not significantly different between groups. In both groups, upper scleral show significantly decreased at 6 months of follow-up (p < 0.001 in both groups); however, improvement of upper scleral show was significantly reduced in patients who had undergone previous double-fold surgery (0.8 ± 0.5 mm) than in nonsurgical patients (1.8 ± 0.5 mm; p < 0.001). Graves eyelid retraction resolves spontaneously over time, albeit not completely. Previous double-fold surgery hinders the degree of spontaneous resolution, probably because of the fibrosis and cicatrization between the skin, the subcutaneous layer, and the levator complex. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  1. Postpartum pelvic floor muscle training and pelvic organ prolapse--a randomized trial of primiparous women.

    PubMed

    Bø, Kari; Hilde, Gunvor; Stær-Jensen, Jette; Siafarikas, Franziska; Tennfjord, Merete Kolberg; Engh, Marie Ellstrøm

    2015-01-01

    Pelvic organ prolapse (POP) is a common and distressing condition. The aim of the present study was to evaluate the effect of pelvic floor muscle training (PFMT) on prevention and treatment of symptoms and signs of POP in primiparous postpartum women. This was a parallel group assessor blind randomized controlled trial. One hundred seventy-five primiparous postpartum women, mean age 29.8 years (standard deviation 4.1), stratified on major levator ani defects or no defect diagnosed by 3-/4-dimensional ultrasound, participated in a 4-month PFMT starting at 6-8 weeks' postpartum or control. All participants had thorough individual instruction and assessment of ability to perform correct pelvic floor muscle contractions. The PFMT group followed a supervised, weekly group training program and performed 3 sets of 8-12 daily maximal contractions at home. Main outcome was POP stage II or greater assessed by POP quantification and bladder neck position assessed by 3-/4- dimensional transperineal ultrasonography. Secondary outcome was symptoms of vaginal bulge using International Consultation on Incontinence Vaginal Symptoms questionnaire. Ninety-six percent of the intervention group adhered to ≥80% of both group and home training sessions. At postintervention, there was no significant risk difference in POP (rational ratio, 1.62; 95% confidence interval, 0.55-4.75), bladder neck position or symptoms of vaginal bulging. No effect was found of postpartum PFMT on POP in primiparous women. More randomized controlled trials are needed before strong conclusions can be drawn on the effect of PFMT on POP in the particular population. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Functional and anatomical differences between continent and incontinent men post radical prostatectomy on urodynamics and 3T MRI: a pilot study.

    PubMed

    Cameron, Anne P; Suskind, Anne M; Neer, Charlene; Hussain, Hero; Montgomery, Jeffrey; Latini, Jerilyn M; DeLancey, John O

    2015-08-01

    There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI). The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. Case-control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. Baseline demographics, surgical approach, and pathology were similar between incontinent (cases) (n = 14) and continent (controls) (n = 12) men. Among the cases, the average 24 hr pad weight was 400.0 ± 176.9 g with a mean of 2.4 ± 0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups; however, with a Kegel maneuver the rise in urethral pressure was 2.6 fold higher in controls. On MRI, the urethral length was 31-35% shorter and the bladder neck was 28.9° more funneled in cases. There were no differences in levator ani muscle size between groups. There was distortion of the sphincter area in 85.7% of cases and in 16.7% of controls (P = 0.001). Men with PPI were not able to increase urethral pressure with a Kegel maneuver despite similar resting urethral pressure profiles. Additionally, incontinent men had shorter urethras and were more likely to have distortion of the sphincter area. All suggesting that the sphincter in men with PPI is both diminutive and poorly functional. © 2014 Wiley Periodicals, Inc.

  3. FUNCTIONAL AND ANATOMICAL DIFFERENCES BETWEEN CONTINENT AND INCONTINENT MEN POST RADICAL PROSTATECTOMY ON URODYNAMICS AND 3T MRI: A PILOT STUDY

    PubMed Central

    Cameron, Anne P.; Suskind, Anne M.; Neer, Charlene; Hussain, Hero; Montgomery, Jeffrey; Latini, Jerilyn M.; DeLancey, John O

    2014-01-01

    Aims There are competing hypotheses about the etiology of post prostatectomy incontinence (PPI).The purpose of this study was to determine the anatomical and functional differences between men with and without PPI. Methods Case control study of continent and incontinent men after radical prostatectomy who underwent functional and anatomic studies with urodynamics and 3.0 Tesla MRI. All men were at least 12 months post prostatectomy and none had a history of pelvic radiation or any prior surgery for incontinence. Results Baseline demographics, surgical approach and pathology were similar between incontinent (cases) (n=14) and continent (controls) (n=12) men. Among the cases, the average 24 hour pad weight was 400.0 ±176.9 grams with a mean of 2.4 ±0.7 pads per day. Urethral pressure profiles at rest did not significantly differ between groups; however with a Kegel maneuver the rise in urethral pressure was 2.6 fold higher in controls. On MRI, the urethral length was 31–35% shorter and the bladder neck was 28.9 degrees more funneled in cases. There were no differences in levator ani muscle size between groups. There was distortion of the sphincter area in 85.7% of cases and in 16.7% of controls (p=0.001). Conclusions Men with PPI were not able to increase urethral pressure with a Kegel maneuver despite similar resting urethral pressure profiles. Additionally, incontinent men had shorter urethras and were more likely to have distortion of the sphincter area. All suggesting that the sphincter in men with PPI is both diminutive and poorly functional. PMID:24752967

  4. Occult thyroid eye disease in patients with unexplained ocular misalignment identified by standardized orbital echography.

    PubMed

    Volpe, Nicholas J; Sbarbaro, James A; Gendron Livingston, Kym; Galetta, Steven L; Liu, Grant T; Balcer, Laura J

    2006-07-01

    To describe the clinical presentation, orbital echography (OE) findings, and neuroimaging results of patients with chronic unexplained ocular misalignment, which includes patients with clinically occult thyroid eye disease (TED) that is identifiable through a characteristic OE appearance. Retrospective observational case series. Seventy-eight patients with chronic ocular misalignment suspected of TED because of a history of systemic thyroid disease, proptosis, dysmotility, positive forced ductions, or eyelid retraction or lag were categorized as TED positive, negative, and indeterminate with the use of standardized OE. Demographic, clinical, OE, computed tomography, and magnetic resonance imaging information was collected. Analyses determined the prevalence of TED and differences between TED positive, negative, and indeterminate groups. Fifty-five percent of the findings were suspicious for and most consistent with TED (TED positive); 26% of the findings were TED negative, and 19% of the findings were TED indeterminate. Of 30 patients with newly diagnosed TED by OE, 70% had no lid retraction, and 20% had no other findings of TED. The inferior rectus followed by the superior rectus/levator complex, medial rectus, and lateral rectus muscles were the most frequently involved muscles. Neuroimaging that was performed in only 26 of 78 patients (33%) did not appear to yield additional diagnostic information. TED is a potential cause of chronic unexplained ocular misalignment in a substantial proportion of patients. These patients frequently present in an occult fashion without other clinical findings that are typical of TED. In these patients, a diagnosis of TED by OE can reduce further costly evaluation. OE appears to have significant clinical usefulness in the diagnosis of TED in patients with unexplained ocular misalignment.

  5. Pharmacodynamics of selective androgen receptor modulators.

    PubMed

    Yin, Donghua; Gao, Wenqing; Kearbey, Jeffrey D; Xu, Huiping; Chung, Kiwon; He, Yali; Marhefka, Craig A; Veverka, Karen A; Miller, Duane D; Dalton, James T

    2003-03-01

    The present study aimed to identify selective androgen receptor modulators (SARMs) with in vivo pharmacological activity. We examined the in vitro and in vivo pharmacological activity of four chiral, nonsteroidal SARMs synthesized in our laboratories. In the in vitro assays, these compounds demonstrated moderate to high androgen receptor (AR) binding affinity, with K(i) values ranging from 4 to 37 nM, and three of the compounds efficaciously stimulated AR-mediated reporter gene expression. The compounds were then administered subcutaneously to castrated rats to appraise their in vivo pharmacological activity. Androgenic activity was evaluated by the ability of these compounds to maintain the weights of prostate and seminal vesicle, whereas levator ani muscle weight was used as a measure of anabolic activity. The maximal response (E(max)) and dose for half-maximal effect (ED(50)) were determined for each compound and compared with that observed for testosterone propionate (TP). Compounds S-1 and S-4 demonstrated in vivo androgenic and anabolic activity, whereas compounds S-2 and S-3 did not. The activities of S-1 and S-4 were tissue-selective in that both compounds stimulated the anabolic organs more than the androgenic organs. These two compounds were less potent and efficacious than TP in androgenic activity, but their anabolic activity was similar to or greater than that of TP. Neither S-1 nor S-4 caused significant luteinizing hormone or follicle stimulating hormone suppression at doses near the ED(50) value. Thus, compounds S-1 and S-4 were identified as SARMs with potent and tissue-selective in vivo pharmacological activity, and represent the first members of a new class of SARMs with selective anabolic effects.

  6. Bone anabolic effects of S-40503, a novel nonsteroidal selective androgen receptor modulator (SARM), in rat models of osteoporosis.

    PubMed

    Hanada, Keigo; Furuya, Kazuyuki; Yamamoto, Noriko; Nejishima, Hiroaki; Ichikawa, Kiyonoshin; Nakamura, Tsutomu; Miyakawa, Motonori; Amano, Seiji; Sumita, Yuji; Oguro, Nao

    2003-11-01

    A novel nonsteroidal androgen receptor (AR) binder, S-40503, was successfully generated in order to develop selective androgen receptor modulators (SARMs). We evaluated the binding specificity for nuclear receptors (NRs) and osteoanabolic activities of S-40503 in comparison with a natural nonaromatizable steroid, 5alpha-dihydrotestosterone (DHT). The compound preferentially bound to AR with nanomolar affinity among NRs. When S-40503 was administrated into orchiectomized (ORX) rats for 4 weeks, bone mineral density (BMD) of femur and muscle weight of levator ani were increased as markedly as DHT, but prostate weight was not elevated over the normal at any doses tested. In contrast, DHT administration caused about 1.5-fold increase in prostate weight. The reduced virilizing activity was clearly evident from the result that 4-week treatment of normal rats with S-40503 showed no enlargement of prostate. To confirm the bone anabolic effect, S-40503 was given to ovariectomized (OVX) rats for 2 months. The compound significantly increased the BMD and biomechanical strength of femoral cortical bone, whereas estrogen, anti-bone resorptive hormone, did not. The increase in periosteal mineral apposition rate (MAR) of the femur revealed direct bone formation activity of S-40503. It was unlikely that the osteoanabolic effect of the compound was attribute to the enhancement of muscle mass, because immobilized ORX rats treated with S-40503 showed a marked increase in BMD of tibial cortical bone without any actions on the surrounding muscle tissue. Collectively, our novel compound served as a prototype for SARMs, which had unique tissue selectivity with high potency for bone formation and lower impact upon sex accessory tissues.

  7. Assessment of 3-nitro-1,2,4-triazol-5-one as a potential endocrine disrupting chemical in rats using the Hershberger and uterotrophic bioassays.

    PubMed

    Quinn, M J; Bannon, D I; Jackovitz, A M; Hanna, T L; Shiflett, A A; Johnson, M S

    2014-01-01

    The explosive 3-nitro-1,2,4-triazol-5-one (NTO) is an insensitive formulation developed to replace high energetics that are susceptible to accidental detonation from heat, shock, and impact. Although studies have shown NTO to be nontoxic at acute exposures, recent subacute and subchronic tests have demonstrated effects on testes and subsequent sperm production in rats. This study assessed endocrine disruption as a potential mechanism for these reproductive effects via the Hershberger and uterotrophic bioassays. These assays are 2 of the US Environmental Protection Agency's tier 1 in vivo screens for the Endocrine Disruptor Screening Program that measure differences in androgen- and estrogen-sensitive tissue weights in castrated and ovariectomized rats. The gonadectomized rats were orally exposed to NTO in a corn oil vehicle at doses of 250, 500, or 1000 mg/kg body weight (bw)/d for 10 and 3 days for the Hershberger and uterotrophic assays, respectively, according to standard protocols. Male rats also received testosterone (0.2 mg/kg/d, subcutaneous) and antiandrogenic flutamide (3mg/kg/d, oral) as negative and positive controls, and females received 17 α-ethynyl estradiol (0.3 µg/d, subcutaneous) as positive controls. 3-Nitro-1,2,4-triazol-5-one caused neither a decrease in androgen-sensitive male reproductive selected tissue (seminal vesicles with fluid/without fluid, glans penis, Cowper gland, ventral prostrate, and levator ani-bulbocavernosus) weights nor a change in uterine weights. The results of this study provide no evidence to suggest that NTO acts like an estrogenic or antiandrogenic endocrine disruptor in rats at these doses. © The Author(s) 2014.

  8. Innovation in the imaging perianal fistula: a step towards personalised medicine

    PubMed Central

    Sahnan, Kapil; Adegbola, Samuel O.; Tozer, Philip J.; Patel, Uday; Ilangovan, Rajpandian; Warusavitarne, Janindra; Faiz, Omar D.; Hart, Ailsa L.; Phillips, Robin K. S.; Lung, Phillip F. C.

    2018-01-01

    Background: Perianal fistula is a topic both hard to understand and to teach. The key to understanding the treatment options and the likely success is deciphering the exact morphology of the tract(s) and the amount of sphincter involved. Our aim was to explore alternative platforms better to understand complex perianal fistulas through three-dimensional (3D) imaging and reconstruction. Methods: Digital imaging and communications in medicine images of spectral attenuated inversion recovery magnetic resonance imaging (MRI) sequences were imported onto validated open-source segmentation software. A specialist consultant gastrointestinal radiologist performed segmentation of the fistula, internal and external sphincter. Segmented files were exported as stereolithography files. Cura (Ultimaker Cura 3.0.4) was used to prepare the files for printing on an Ultimaker 3 Extended 3D printer. Animations were created in collaboration with Touch Surgery™. Results: Three examples of 3D printed models demonstrating complex perianal fistula were created. The anatomical components are displayed in different colours: red: fistula tract; green: external anal sphincter and levator plate; blue: internal anal sphincter and rectum. One of the models was created to be split in half, to display the internal opening and allow complexity in the intersphincteric space to better evaluated. An animation of MRI fistulography of a trans-sphincteric fistula tract with a cephalad extension in the intersphincteric space was also created. Conclusion: MRI is the reference standard for assessment of perianal fistula, defining anatomy and guiding surgery. However, communication of findings between radiologist and surgeon remains challenging. Feasibility of 3D reconstructions of complex perianal fistula is realized, with the potential to improve surgical planning, communication with patients, and augment training. PMID:29854001

  9. Multivariate analysis of factors predicting prostate dose in intensity-modulated radiotherapy

    SciTech Connect

    Tomita, Tsuneyuki; Nakamura, Mitsuhiro, E-mail: m_nkmr@kuhp.kyoto-u.ac.jp; Hirose, Yoshinori

    We conducted a multivariate analysis to determine relationships between prostate radiation dose and the state of surrounding organs, including organ volumes and the internal angle of the levator ani muscle (LAM), based on cone-beam computed tomography (CBCT) images after bone matching. We analyzed 270 CBCT data sets from 30 consecutive patients receiving intensity-modulated radiation therapy for prostate cancer. With patients in the supine position on a couch with the HipFix system, data for center of mass (COM) displacement of the prostate and the state of individual organs were acquired and compared between planning CT and CBCT scans. Dose distributions weremore » then recalculated based on CBCT images. The relative effects of factors on the variance in COM, dose covering 95% of the prostate volume (D{sub 95%}), and percentage of prostate volume covered by the 100% isodose line (V{sub 100%}) were evaluated by a backward stepwise multiple regression analysis. COM displacement in the anterior-posterior direction (COM{sub AP}) correlated significantly with the rectum volume (δVr) and the internal LAM angle (δθ; R = 0.63). Weak correlations were seen for COM in the left-right (R = 0.18) and superior-inferior directions (R = 0.31). Strong correlations between COM{sub AP} and prostate D{sub 95%} and V{sub 100%} were observed (R ≥ 0.69). Additionally, the change ratios in δVr and δθ remained as predictors of prostate D{sub 95%} and V{sub 100%}. This study shows statistically that maintaining the same rectum volume and LAM state for both the planning CT simulation and treatment is important to ensure the correct prostate dose in the supine position with bone matching.« less

  10. New insights into dinosaur jaw muscle anatomy.

    PubMed

    Holliday, Casey M

    2009-09-01

    Jaw muscles are key components of the head and critical to testing hypotheses of soft-tissue homology, skull function, and evolution. Dinosaurs evolved an extraordinary diversity of cranial forms adapted to a variety of feeding behaviors. However, disparate evolutionary transformations in head shape and function among dinosaurs and their living relatives, birds and crocodylians, impair straightforward reconstructions of muscles, and other important cephalic soft tissues. This study presents the osteological correlates and inferred soft tissue anatomy of the jaw muscles and relevant neurovasculature in the temporal region of the dinosaur head. Hypotheses of jaw muscle homology were tested across a broad range archosaur and sauropsid taxa to more accurately infer muscle attachments in the adductor chambers of non-avian dinosaurs. Many dinosaurs likely possessed m. levator pterygoideus, a trait shared with lepidosaurs but not extant archosaurs. Several major clades of dinosaurs (e.g., Ornithopoda, Ceratopsidae, Sauropoda) eliminated the epipterygoid, thus impacting interpretations of m. pseudotemporalis profundus. M. pseudotemporalis superficialis most likely attached to the caudoventral surface of the laterosphenoid, a trait shared with extant archosaurs. Although mm. adductor mandibulae externus profundus and medialis likely attached to the caudal half of the dorsotemporal fossa and coronoid process, clear osteological correlates separating the individual bellies are rare. Most dinosaur clades possess osteological correlates indicative of a pterygoideus ventralis muscle that attaches to the lateral surface of the mandible, although the muscle may have extended as far as the jugal in some taxa (e.g., hadrosaurs, tyrannosaurs). The cranial and mandibular attachments of mm adductor mandibulae externus superficialis and adductor mandibulae posterior were consistent across all taxa studied. These new data greatly increase the interpretive resolution of head anatomy in

  11. Anatomy of the feeding apparatus of the nurse shark, Ginglymostoma cirratum.

    PubMed

    Motta; Wilga

    1999-07-01

    The anatomy of the feeding apparatus of the nurse shark, Ginglymostoma cirratum, was investigated by gross dissection and computer axial tomography. The labial cartilages, jaws, jaw suspension, muscles, and ligaments of the head are described. Palatoquadrate cartilages articulate with the chondrocranium caudally by short, laterally projecting hyomandibulae and rostrally by ethmoorbital articulations. Short orbital processes of the palatoquadrates are joined to the ethmoid region of the chondrocranium by short, thin ethmopalatine ligaments. In addition, various ligaments, muscles, and the integument contribute to the suspension of the jaws. When the mouth is closed and the palatoquadrate retracted, the palatine process of the palatoquadrate is braced against the ventral surface of the nasal capsule and the ascending process of the palatoquadrate is in contact with the rostrodorsal end of the suborbital shelf. When the mandible is depressed and the palatoquadrate protrudes slightly rostroventrally, the palatoquadrate moves away from the chondrocranium. A dual articulation of the quadratomandibular joint restricts lateral movement between the mandible and the palatoquadrate. The vertically oriented preorbitalis muscle spans the gape and is hypothesized to contribute to the generation of powerful crushing forces for its hard prey. The attachment of the preorbitalis to the prominent labial cartilages is also hypothesized to assist in the retraction of the labial cartilages during jaw closure. Separate levator palatoquadrati and spiracularis muscles, which are longitudinally oriented and attach the chondrocranium to the palatoquadrate, are hypothesized to assist in the retraction of the palatoquadrate during the recovery phase of feeding kinematics. Morphological specializations for suction feeding that contribute to large subambient suction pressures include hypertrophied coracohyoideus and coracobranchiales muscles to depress the hyoid and branchial arches, a small

  12. Blepharoptosis surgery in patients with myasthenia gravis.

    PubMed

    Litwin, Andre S; Patel, Bhupendra; McNab, Alan A; McCann, John D; Leatherbarrow, Brian; Malhotra, Raman

    2015-07-01

    To review our approach of cautious surgical correction of blepharoptosis in patients with myasthenia gravis (MG) to minimise risk of exposure complications. Retrospective case note review of 30 patients with symptomatic eyelid concerns despite appropriate medical treatment, who underwent eyelid surgery. The mean age at diagnosis was 47 years. 13/30 patients had systemic MG, 14/30 ocular MG and 3/30 congenital MG. The main outcome measures were improvement in eyelid height and/or position, duration of a successful postoperative result, need for further surgical intervention, and intraoperative or postoperative complications. 38 blepharoptosis procedures were performed on 23 patients. Mean age at time of surgery was 62 years, with an average follow-up of 29 months. 10 patients (16 eyelids) underwent anterior approach levator advancement, 4 patients (5 eyelids) posterior approach surgery and 8 patients (15 eyelids) brow suspension. One patient (2 eyelids) had tarsal switch surgery. An average improvement in eyelid height of 1.9 mm was achieved. Postoperative symptoms or signs of exposure keratopathy occurred in 17% of patients. This necessitated lid lowering in one eyelid of one patient. During follow-up, 37% of eyelids required further surgical intervention to improve the upper eyelid height, after an average of 19 months (range 0.5-49 months). Over a third of patients in our series required repeat surgery, which would be expected when the initial aim was to under-correct this group. In contrast to previous commentaries, the amount of eyelid excursion was not the main factor used to guide the surgical approach. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women

    PubMed Central

    Amorim, Amanda C.; Cacciari, Licia P.; Passaro, Anice C.; Silveira, Simone R. B.; Amorim, Cesar F.; Loss, Jefferson F.

    2017-01-01

    Pelvic floor muscle (PFM) force and coordination are related to urinary incontinence severity and to sexual satisfaction. Health professionals frequently combine classic PFM exercises with hip adduction/abduction contraction to treat these disorders, but the real benefits of this practice are still unknown. Based on a theoretical anatomy approach whereby the levator ani muscle is inserted into the obturator internus myofascia and in which force generated by hip movements should increase the contraction quality of PFMs, our aim was to investigate the effects of isometric hip adduction and abduction on PFM force generation. Twenty healthy, nulliparous women were evaluated using two strain-gauge dynamometers (one cylinder-like inside the vaginal cavity, and the other measuring hip adduction/abduction forces around both thighs) while performing three different tasks: (a) isolated PFM contraction; (b) PFM contraction combined with hip adduction (30% and 50% maximum hip force); and (c) PFM contraction combined with hip abduction (30% and 50% maximum hip force). Data were sampled at 100Hz and subtracted from the offset if existent. We calculated a gradient between the isolated PFM contraction and each hip condition (Δ Adduction and Δ Abduction) for all variables: Maximum force (N), instant of maximum-force occurrence (s), mean force in an 8-second window (N), and PFM force loss (N.s). We compared both conditions gradients in 30% and 50% by paired t-tests. All variables did not differ between hip conditions both in 30% and 50% of maximum hip force (p>.05). PFM contraction combined with isometric hip abduction did not increase vaginal force in healthy and nulliparous women compared to PFM contraction combined with isometric hip adduction. Therefore, so far, the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance. PMID:28542276

  14. Co-contraction behaviour of masticatory and neck muscles during tooth grinding.

    PubMed

    Giannakopoulos, N N; Schindler, H J; Hellmann, D

    2018-07-01

    The objective of this study was to analyse the co-contraction behaviour of jaw and neck muscles during force-controlled experimental grinding in the supine position. Twelve symptom-free subjects were enrolled in the experimental study. Electromyographic (EMG) activity of semispinalis capitis, splenius capitis and levator scapulae muscles was recorded bilaterally with intramuscular fine-wire electrodes, whereas that of sternocleidomastoideus, infrahyoidal, suprahyoidal, masseter and anterior temporalis muscles were registered with surface electrodes. EMG and force measurements were performed during tasks simulating tooth grinding on custom-made intraoral metal splints. The mean EMG activity normalised by maximum voluntary contraction (% MVC) of each of the neck muscles studied during grinding was analysed and compared with previous data from jaw clenching at identical force (100 N) and (supine) position. The occurrence of low-level, long-lasting tonic activation (LLTA) of motor units was also documented. The mean three-dimensional force vector of the grinding forces was 106 ± 74 N. In the frontal plane, the incline to the midsagittal plane ranged between 10° and 15°. In the midsagittal plane, the incline to the frontal plane was negligibly small. Posterior neck muscle activity during grinding ranged between 4.5% and 12% MVC and during clenching with 100 N between 1.8% and 9.9% MVC. Masticatory muscle activity during grinding ranged between 17% and 21% MVC for contralateral masseter and ipsilateral temporalis and between 4% and 6.5% for ipsilateral masseter and contralateral temporalis. LLTA had an average duration of 195 ± 10 seconds. The findings from this study do not support pathophysiological muscle chain theories postulating simple biomechanical coupling of neck and jaw muscles. Co-contractions of neck and masticatory muscles may instead occur as a result of complex neurophysiological interactions. © 2018 John Wiley & Sons Ltd.

  15. The impact of specialized physiotherapy methods on BODE index in COPD patients during hospitalization.

    PubMed

    Kurzaj, Monika; Wierzejski, Władysław; Dor, Anna; Stawska, Jolanta; Rożek, Krystyna

    2013-01-01

    To evaluate the effectiveness of specialized physiotherapy methods measured by the BODE index in patients with COPD during hospitalization. The study was conducted on a group of 30 patients diagnosed with COPD, all under treatment at the clinical hospital in Wroclaw due to the exacerbation of their symptoms. All patients were undergoing standard pharmacological treatment along with basic physiotherapy. The subjects of the study were randomly divided between an experimental group of 20 persons and a control group of 10 persons. Patients in the experimental group underwent a series of 6 additional massage treatments performed over a period of a few days, aimed at reshaping the following muscles: the sterno-cleidomastoid, pectoralis major, pectoralis minor, trapezius, levator scapulae, rhomboids and serratus anterior. Each massage lasted for 30 minutes and consisted of stroking, grinding, vibration and kneading techniques. Before and after therapy the patients were assessed based on the BODE index. First, the patient's BMI was calculated (B). Airflow obstruction (O) was determined by the percentage value of FEV1 while the MRC scale was used to evaluate a patient's dyspnea (D). Exercise capacity (E) was measured by the distance a patient could cover in a 6-minute walk test. Each variable of the BODE index was ranked on a scale from 0 to 3 points except the BMI, for which was given either 0 or 1 point. Analysis of the results showed a significant improvement of the BODE index in the experimental group while in the control group this ratio changed slightly. The FEV1 and MRC parameters changed significantly only in the experimental group. After a week of therapy the BODE index improved in both groups, but in the experimental group there was a significantly higher difference. In the experimental group all BODE components except BMI improved highly significantly, whereas in the control group only exercise capacity was significantly improved.

  16. Hershberger Assays for Di-2-ethylhexyl Phthalate and Its Substitute Candidates

    PubMed Central

    Kim, Hee-Su; Cheon, Yong-Pil; Lee, Sung-Ho

    2018-01-01

    ABSTRACT In the present study, we employed Hershberger assay to determine possible androgenic or antiandrogenic activities of three di-2-ethylhexyl phthalate (DEHP) substitute candidates. The assay was carried out using immature castrated Sprague–Dawley male rats. After 7 days of the surgery, testosterone propionate (TP, 0.4 mg/kg/day) and test materials (low dose, 40 mg/kg/day; high dose, 400 mg/kg/day) were administered for 10 consecutive days by subcutaneous (s.c.) injection and oral gavage, respectively. Test materials were DEHP, 2-ethylhexyl oleate (IOO), 2-ethylhexyl stearate (IOS) and triethyl 2-acetylcitrate (ATEC). The rats were necropsied, and then the weights of five androgen-dependent tissues [ventral prostate, seminal vesicle, coagulating glands, levator ani-bulbocavernosus (LABC) muscle, paired Cowper’s glands, and glans penis] and four androgen-insensitive tissues (kidney, adrenal glands, spleen and liver) were measured. All test materials including DEHP did not exhibit any androgenic activity in the assay. On the contrary, antiandrogen-like activities were found in all test groups, and the order of the intensity was ATEC < DEHP < ISO < IOO in the five androgen-sensitive tissues. There was no statistical difference between low dose treatment and high dose treatment of all replacement candidate groups. In DEHP groups, high dose treatment exhibited significant weight gains in LABC and Glan Penis. There was no statistical difference in androgen-insensitive tissue measurements. Since the effects of ATEC treatment on the accessory sex organs were much less or not present at all when compared to those of DEHP, ATEC could be a strong candidate to replace DEHP. IOO treatment brought most severe weight reduction in all of androgen-sensitive tissues, so this material should be excluded for further screening of DEHP substitute selection. PMID:29707681

  17. Multicentre propensity score-matched analysis of conventional versus extended abdominoperineal excision for low rectal cancer.

    PubMed

    Ortiz, H; Ciga, M A; Armendariz, P; Kreisler, E; Codina-Cazador, A; Gomez-Barbadillo, J; Garcia-Granero, E; Roig, J V; Biondo, S

    2014-06-01

    Abdominal perineal excision (APE) was originally described with levator ani removal for rectal cancer. An even wider, more aggressive extralevator resection for APE has been proposed. Although some surgeons are performing a very wide 'extralevator APE (ELAPE)', there are few data to recommend it routinely. This multicentre study aimed to compare outcomes of APE and ELAPE. A multicentre propensity case-matched analysis comparing two surgical approaches (APE and ELAPE) was performed. All patients who underwent abdominoperineal resection of a rectal tumour were considered for the analysis. Tumour height was defined by magnetic resonance imaging measurement and patients with stage II-III tumours had neoadjuvant radiochemotherapy. Involvement of the circumferential resection margin (CRM) and intraoperative tumour perforation were the main outcome measures. A logistic regression model was used to study the relationship between the surgical approaches and outcomes. From January 2008 to March 2013 a total of 1909 consecutive patients underwent APE or ELAPE, of whom 914 matched patients (457 in each group) formed the cohort for analysis. Intraoperative tumour perforation occurred in 7.9 and 7.7 per cent of patients during APE and ELAPE respectively (P = 0.902), and there was CRM involvement in 13.1 and 13.6 per cent (P = 0.846). There were no differences between APE and ELAPE in terms of postoperative complication rates (52.3 versus 48.1 per cent; P = 0.209), need for reoperation (7.7 versus 7.0 per cent; P = 0.703), perineal wound problems (26.0 versus 21.9 per cent; P = 0.141), mortality rate (2.0 versus 2.0 per cent; P = 1.000) and local recurrence rate at 2 years (2.7 versus 5.6 per cent; P = 0.664). ELAPE does not improve rates of CRM involvement, intraoperative tumour perforation, local recurrence or mortality. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  18. CLINICAL APPLICATION OF THE RIGHT SIDELYING RESPIRATORY LEFT ADDUCTOR PULL BACK EXERCISE

    PubMed Central

    2013-01-01

    Problem: Lumbopelvic‐femoral conditions are common and may be associated with asymmetrical musculoskeletal and respiratory impairments and postural mal‐alignment called a Left Anterior Interior Chain (AIC) pattern. An inherent pattern of asymmetry involves the trunk/ribs/spine/pelvis/hip joints and includes the tendency to stand on the right leg and shift the center of gravity to the right which may result for example, in a tight left posterior hip capsule, poorly approximated left hip, long/weak left adductors, internal obliques (IO) and transverse abdominus (TA), short/strong/over active paraspinals and muscles on the right anterior outlet (adductors, levator ani and obturator internus), a left rib flare and a decreased respiratory diaphragm zone of apposition (ZOA). The Solution: A therapeutic exercise technique that can address impairments associated with postural asymmetry may be beneficial in improving function, reducing and/or eliminating pain causation, and improving breathing. The Right Sidelying Left Respiratory Adductor Pull Back is an exercise designed to affect alignment of the lumbopelvic‐femoral region by influencing the left posterior ischiofemoral ligament, ZOA and right anterior outlet and left anterior inlet (rectus femoris, sartorius), activating/shortening the left adductors, left IO/TA's and inhibiting/lengthening the paraspinals, bilaterally. Discussion: The exercise technique is often used by Physical Therapists, Physical Therapist assistants and Athletic Trainers as an initial exercise to positively affect position/alignment of the lumbopelvic‐femoral region, referred to as “repositioning,” by clinicians who use it. Four published case studies have used similar exercises to address the above impairments associated with a Left AIC pattern and in each 100% improvement in function and pain intensity was described. This particular exercise technique is relatively new and warrants future research. PMID:23772350

  19. Electromyographic assessment of apple bucket intervention designed to reduce back strain.

    PubMed

    Earle-Richardson, Giulia; Jenkins, Paul L; Strogatz, David; Bell, Erin M; Freivalds, Andris; Sorensen, Julie A; May, John J

    2008-06-01

    The authors previously developed an apple bucket that was modified by use of a hip belt to reduce muscle fatigue. The intervention of belt use was accepted by workers and shown not to interfere with productivity. However, use of this intervention did not appear to reduce muscle fatigue when measured by tests of voluntary muscle strength. The purpose of the present study was to evaluate the intervention's effect on muscle fatigue employing surface electromyographic (EMG) amplitude. Amplitude measurements on 15 muscles were taken from 10 laboratory volunteers who were carrying a full bucket of apples, once while wearing the intervention belt and once without the intervention. These measurements were taken for seven different postures (four angles of trunk flexion (0 degrees , 20 degrees , 45 degrees , 90 degrees ) and three raised-arm positions (both up, dominant up, non-dominant up)) common to apple harvest work. Participants were measured in these conditions both with the bucket carried in front and with the bucket carried to the side. Significant reductions in amplitude favouring the intervention were seen for 11 of the 15 muscles in models considering the four body flexion angles. Ten of these were of the middle and lower back. These control/intervention differences were seen with both bucket-carrying positions (front vs. side) and tended to increase with increasing flexion angle. In contrast, no significant intervention effects were observed in models considering treatment by arm-raised position. One significant main effect (upper trapezius, side bucket) showed an amplitude reduction in the treatment condition. Another main effect showing increased amplitude in the intervention condition use was observed in the dominant levator scapulae (side bucket). Thus, the use of the intervention belt reduces EMG amplitude among a number of mid- and lower-back muscles. This is suggestive of a protective effect against back strain.

  20. Stereoscopic three-dimensional images of an anatomical dissection of the eyeball and orbit for educational purposes.

    PubMed

    Matsuo, Toshihiko; Takeda, Yoshimasa; Ohtsuka, Aiji

    2013-01-01

    The purpose of this study was to develop a series of stereoscopic anatomical images of the eye and orbit for use in the curricula of medical schools and residency programs in ophthalmology and other specialties. Layer-by-layer dissection of the eyelid, eyeball, and orbit of a cadaver was performed by an ophthalmologist. A stereoscopic camera system was used to capture a series of anatomical views that were scanned in a panoramic three-dimensional manner around the center of the lid fissure. The images could be rotated 360 degrees in the frontal plane and the angle of views could be tilted up to 90 degrees along the anteroposterior axis perpendicular to the frontal plane around the 360 degrees. The skin, orbicularis oculi muscle, and upper and lower tarsus were sequentially observed. The upper and lower eyelids were removed to expose the bulbar conjunctiva and to insert three 25-gauge trocars for vitrectomy at the location of the pars plana. The cornea was cut at the limbus, and the lens with mature cataract was dislocated. The sclera was cut to observe the trocars from inside the eyeball. The sclera was further cut to visualize the superior oblique muscle with the trochlea and the inferior oblique muscle. The eyeball was dissected completely to observe the optic nerve and the ophthalmic artery. The thin bones of the medial and inferior orbital wall were cracked with a forceps to expose the ethmoid and maxillary sinus, respectively. In conclusion, the serial dissection images visualized aspects of the local anatomy specific to various procedures, including the levator muscle and tarsus for blepharoptosis surgery, 25-gauge trocars as viewed from inside the eye globe for vitrectomy, the oblique muscles for strabismus surgery, and the thin medial and inferior orbital bony walls for orbital bone fractures.

  1. Pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging.

    PubMed

    Hampel, Franziska; Hallscheidt, Peter; Sohn, Christof; Schlehe, Bettina; Brocker, Kerstin A

    2018-02-21

    To perform pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging (3T MRI). Twenty-five nulliparous volunteers and 25 primiparous women underwent pelvic 3T MRI within one week after vaginal childbirth in a prospective clinical single-center trial. The pelvimetric parameters interspinous distance (ISD), intertuberous distance (ITD), sagittal outlet (SO), obstetric conjugate (OC), and coccygeal curved length (CCL) were adapted from anthropometric measurements as well as from sonographic and computed tomography-based pelvimetry performed on high-resolution T2-weighted images. We compared the results of the two study groups to one another, recent literature and postpartum-diagnosed levator ani muscle (LAM) injuries. The mean values for primipara/nullipara were ISD 107 ± 8.3/105 ± 8.4 mm, ITD 119.8 ± 10.2/118.4 ± 13.1 mm, OC 129.4 ± 10/130.8 ± 6.9 mm, SO 114.3 ± 7.8/112.5 ± 8.9 mm, and CCL 37.3 ± 7.4/39 ± 8 mm. Significant differences (P < 0.05) were found between the results for OC, SO, and CCL (primipara) and ISD, ITD and OC (nullipara) and the values in the literature. No significant difference in pelvimetric values was found between the groups. A significant correlation was found between the pelvimetric parameters and five types of LAM injuries. Two-dimensional 3T MRI combines high-resolution images with objective pelvimetric measurements applicable in a postpartum setting. Our results provide a good foundation for further MRI-based studies evaluating the bony pelvis and its relation to LAM injuries during vaginal childbirth. © 2018 Wiley Periodicals, Inc.

  2. Neck muscle load distribution in lateral, frontal, and rear-end impacts: a three-dimensional finite element analysis.

    PubMed

    Hedenstierna, Sofia; Halldin, Peter; Siegmund, Gunter P

    2009-11-15

    A finite element (FE) model of the human neck was used to study the distribution of neck muscle loads during multidirectional impacts. The computed load distributions were compared to experimental electromyography (EMG) recordings. To quantify passive muscle loads in nonactive cervical muscles during impacts of varying direction and energy, using a three-dimensional (3D) continuum FE muscle model. Experimental and numerical studies have confirmed the importance of muscles in the impact response of the neck. Although EMG has been used to measure the relative activity levels in neck muscles during impact tests, this technique has not been able to measure all neck muscles and cannot directly quantify the force distribution between the muscles. A numerical model can give additional insight into muscle loading during impact. An FE model with solid element musculature was used to simulate frontal, lateral, and rear-end vehicle impacts at 4 peak accelerations. The peak cross-sectional forces, internal energies, and effective strains were calculated for each muscle and impact configuration. The computed load distribution was compared with experimental EMG data. The load distribution in the cervical muscles varied with load direction. Peak sectional forces, internal energies, and strains increased in most muscles with increasing impact acceleration. The dominant muscles identified by the model for each direction were splenius capitis, levator scapulae, and sternocleidomastoid in lateral impacts, splenius capitis, and trapezoid in frontal impacts, and sternocleidomastoid, rectus capitis posterior minor, and hyoids in rear-end impacts. This corresponded with the most active muscles identified by EMG recordings, although within these muscles the distribution of forces and EMG levels were not the same. The passive muscle forces, strains, and energies computed using a continuum FE model of the cervical musculature distinguished between impact directions and peak accelerations

  3. Dose-Effect Relationships for Individual Pelvic Floor Muscles and Anorectal Complaints After Prostate Radiotherapy

    SciTech Connect

    Smeenk, Robert Jan, E-mail: r.smeenk@rther.umcn.nl; Hoffmann, Aswin L.; Hopman, Wim P.M.

    2012-06-01

    Purpose: To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). Methods and Materials: In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed.more » Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. Results: The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: {<=}30 Gy to the IAS; {<=}10 Gy to the EAS; {<=}50 Gy to the PRM; and {<=}40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Conclusions: Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus

  4. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy.

    PubMed

    Smeenk, Robert Jan; Hoffmann, Aswin L; Hopman, Wim P M; van Lin, Emile N J Th; Kaanders, Johannes H A M

    2012-06-01

    To delineate the individual pelvic floor muscles considered to be involved in anorectal toxicity and to investigate dose-effect relationships for fecal incontinence-related complaints after prostate radiotherapy (RT). In 48 patients treated for localized prostate cancer, the internal anal sphincter (IAS) muscle, the external anal sphincter (EAS) muscle, the puborectalis muscle (PRM), and the levator ani muscles (LAM) in addition to the anal wall (Awall) and rectal wall (Rwall) were retrospectively delineated on planning computed tomography scans. Dose parameters were obtained and compared between patients with and without fecal urgency, incontinence, and frequency. Dose-effect curves were constructed. Finally, the effect of an endorectal balloon, which was applied in 28 patients, was investigated. The total volume of the pelvic floor muscles together was about three times that of the Awall. The PRM was exposed to the highest RT dose, whereas the EAS received the lowest dose. Several anal and rectal dose parameters, as well as doses to all separate pelvic floor muscles, were associated with urgency, while incontinence was associated mainly with doses to the EAS and PRM. Based on the dose-effect curves, the following constraints regarding mean doses could be deduced to reduce the risk of urgency: ≤ 30 Gy to the IAS; ≤ 10 Gy to the EAS; ≤ 50 Gy to the PRM; and ≤ 40 Gy to the LAM. No dose-effect relationships for frequency were observed. Patients treated with an endorectal balloon reported significantly less urgency and incontinence, while their treatment plans showed significantly lower doses to the Awall, Rwall, and all pelvic floor muscles. Incontinence-related complaints show specific dose-effect relationships to individual pelvic floor muscles. Dose constraints for each muscle can be identified for RT planning. When only the Awall is delineated, substantial components of the continence apparatus are excluded. Copyright © 2012 Elsevier Inc. All rights

  5. Dynamic Article: Tandem Robotic Technique of Extralevator Abdominoperineal Excision and Rectus Abdominis Muscle Harvest for Immediate Closure of the Pelvic Floor Defect.

    PubMed

    Singh, Puneet; Teng, Edward; Cannon, Lisa M; Bello, Brian L; Song, David H; Umanskiy, Konstantin

    2015-09-01

    Extralevator abdominoperineal excision for distal rectal cancers involves cylindrical excision of the mesorectum with wide division of the levator ani muscles. Although this technique has been shown to decrease local cancer recurrence and improve survival, it leaves the patient with a considerable pelvic floor defect that may require reconstruction. We developed an innovative technique of robotic extralevator abdominoperineal excision combined with robotic harvest of the rectus abdominis muscle flap for immediate reconstruction of the pelvic floor defect. This was a retrospective review pilot study. This study was conducted at a tertiary care cancer center. Three patients who underwent robotic extralevator abdominoperineal excision with robotic rectus abdominis flap harvest for distal rectal adenocarcinoma were included. Intraoperative and postoperative outcomes included operative time, intraoperative complications, length of hospital stay, wound complications, incidence of perineal hernia, persistent pain, and functional limitations. Three patients underwent this procedure. The median operative time was 522 minutes with median hospital stay of 6 days. One patient experienced perineal wound complication requiring limited incision and drainage followed by complete healing of the wound by secondary intention. The other 2 patients did not experience any wound complications. Longest follow-up was 16 months. None of the patients developed perineal hernias during this time period. The small sample size and retrospective nature were limitations. This technique confers multiple advantages including improved visualization and dexterity within the pelvis and accurate wide margins at the pelvic floor. An incisionless robotic flap harvest with preservation of the anterior rectus sheath obviates the risk of ventral hernia while providing robust tissue closure of the radiated abdominoperineal excision wound. This technique may result in faster postoperative recovery, decreased

  6. Effect of combined actions of hip adduction/abduction on the force generation and maintenance of pelvic floor muscles in healthy women.

    PubMed

    Amorim, Amanda C; Cacciari, Licia P; Passaro, Anice C; Silveira, Simone R B; Amorim, Cesar F; Loss, Jefferson F; Sacco, Isabel C N

    2017-01-01

    Pelvic floor muscle (PFM) force and coordination are related to urinary incontinence severity and to sexual satisfaction. Health professionals frequently combine classic PFM exercises with hip adduction/abduction contraction to treat these disorders, but the real benefits of this practice are still unknown. Based on a theoretical anatomy approach whereby the levator ani muscle is inserted into the obturator internus myofascia and in which force generated by hip movements should increase the contraction quality of PFMs, our aim was to investigate the effects of isometric hip adduction and abduction on PFM force generation. Twenty healthy, nulliparous women were evaluated using two strain-gauge dynamometers (one cylinder-like inside the vaginal cavity, and the other measuring hip adduction/abduction forces around both thighs) while performing three different tasks: (a) isolated PFM contraction; (b) PFM contraction combined with hip adduction (30% and 50% maximum hip force); and (c) PFM contraction combined with hip abduction (30% and 50% maximum hip force). Data were sampled at 100Hz and subtracted from the offset if existent. We calculated a gradient between the isolated PFM contraction and each hip condition (Δ Adduction and Δ Abduction) for all variables: Maximum force (N), instant of maximum-force occurrence (s), mean force in an 8-second window (N), and PFM force loss (N.s). We compared both conditions gradients in 30% and 50% by paired t-tests. All variables did not differ between hip conditions both in 30% and 50% of maximum hip force (p>.05). PFM contraction combined with isometric hip abduction did not increase vaginal force in healthy and nulliparous women compared to PFM contraction combined with isometric hip adduction. Therefore, so far, the use of hip adduction or abduction in PFM training and treatments are not justified for improving PFM strength and endurance.

  7. Does general exercise training before and during pregnancy influence the pelvic floor "opening" and delivery outcome? A 3D/4D ultrasound study following nulliparous pregnant women from mid-pregnancy to childbirth.

    PubMed

    Bø, Kari; Hilde, Gunvor; Staer-Jensen, Jette; Siafarikas, Franziska; Tennfjord, Merete Kolberg; Engh, Marie Ellstrøm

    2015-02-01

    It has been suggested that women who are regular exercisers have a tighter pelvic floor and thereby have more difficulty during childbirth than non-exercising women. We investigated whether women exercising before and during pregnancy have a narrower levator hiatus (LH) area than their sedentary counterparts. We also studied whether regular exercise at gestational week 37 influences delivery outcome. Cohort study of 274 nulliparous pregnant women assessed at mid-pregnancy and gestational week 37 by three-dimensional/four-dimensional transperineal ultrasonography of the LH area. Exercisers were defined as those exercising ≥30 min three times per week and non-exercisers as not exercising. Exercise data were collected via electronic questionnaire at mean gestational weeks 21 and 37. Labour and delivery outcomes were collected from the women's electronic medical birth records. Differences between exercisers and non-exercisers were analysed using independent sample t test or χ(2) test. p Value was set to ≤0.05. At gestational week 37, exercisers had a significantly larger LH area than non-exercisers at rest and during PFM contraction (mean difference -1.6 cm(2) (95% CI -3.0 to -0.3), p=0.02 and -1.1 cm(2) (95% CI -2.0 to -0.1), p=0.04, respectively). No significant differences were found between exercisers and non-exercisers at week 37 in any labour or delivery outcomes. The results of the present study do not support the hypothesis that women exercising regularly before or during pregnancy have a narrower LH area or more complicated childbirths than non-exercising women. ClinicalTrials.gov: NCT01045135. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Referred pain from myofascial trigger points in head and neck-shoulder muscles reproduces head pain features in children with chronic tension type headache.

    PubMed

    Fernández-de-las-Peñas, César; Fernández-Mayoralas, Daniel M; Ortega-Santiago, Ricardo; Ambite-Quesada, Silvia; Palacios-Ceña, Domingo; Pareja, Juan A

    2011-02-01

    Our aim was to describe the referred pain pattern and areas from trigger points (TrPs) in head, neck, and shoulder muscles in children with chronic tension type headache (CTTH). Fifty children (14 boys, 36 girls, mean age: 8 ± 2) with CTTH and 50 age- and sex- matched children participated. Bilateral temporalis, masseter, superior oblique, upper trapezius, sternocleidomastoid, suboccipital, and levator scapula muscles were examined for TrPs by an assessor blinded to the children's condition. TrPs were identified with palpation and considered active when local and referred pains reproduce headache pain attacks. The referred pain areas were drawn on anatomical maps, digitalized, and also measured. The total number of TrPs was significantly greater in children with CTTH as compared to healthy children (P < 0.001). Active TrPs were only present in children with CTTH (P < 0.001). Within children with CTTH, a significant positive association between the number of active TrPs and headache duration (r (s) = 0.315; P = 0.026) was observed: the greater the number of active TrPs, the longer the duration of headache attack. Significant differences in referred pain areas between groups (P < 0.001) and muscles (P < 0.001) were found: the referred pain areas were larger in CTTH children (P < 0.001), and the referred pain area elicited by suboccipital TrPs was larger than the referred pain from the remaining TrPs (P < 0.001). Significant positive correlations between some headache clinical parameters and the size of the referred pain area were found. Our results showed that the local and referred pains elicited from active TrPs in head, neck and shoulder shared similar pain pattern as spontaneous CTTH in children, supporting a relevant role of active TrPs in CTTH in children.

  9. OECD validation of the Hershberger assay in Japan: phase 2 dose response of methyltestosterone, vinclozolin, and p,p'-DDE.

    PubMed Central

    Yamasaki, Kanji; Sawaki, Masakuni; Ohta, Ryo; Okuda, Hirokazu; Katayama, Seiichi; Yamada, Tomoya; Ohta, Takafumi; Kosaka, Tadashi; Owens, William

    2003-01-01

    The Organisation for Economic Co-operation and Development has initiated the development of new guidelines for the screening and testing of potential endocrine disruptors. The Hershberger assay is one of the assays selected for validation based on the need for in vivo screening to detect androgen agonists or antagonists by measuring the response of five sex accessory organs and tissues of castrated juvenile male rats: the ventral prostate, the seminal vesicles with coagulating glands, the levator ani and bulbocavernosus muscle complex, the Cowper's glands, and the glans penis. The phase 1 feasibility demonstration stage of the Hershberger validation program has been successfully completed with a single androgen agonist and a single antagonist as reference substances. The phase 2 validation program employs a range of additional androgen agonists and antagonists as well as 5alpha-reductase inhibitors. Seven Japanese laboratories have contributed phase 2 validation studies of the Hershberger assay using methyltestosterone, vinclozolin, and 2,2-bis (4-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE). The methyltestosterone doses were 0, 0.05, 0.5, 5, and 50 mg/kg/day, and the vinclozolin and p,p'-DDE doses were 0, 3, 10, 30, and 100 mg/kg/day. All chemicals were orally administered by gavage for 10 consecutive days. In the antagonist version of the assay using vinclozolin and p,p'-DDE, 0.2 mg/kg/day of testosterone propionate was coadministered by subcutaneous injection. All five accessory sex preproductive organs and tissues consistently responded with statistically significant changes in weight within a narrow window. Therefore, the Japanese studies support the Hershberger assay as a reliable and reproducible screening assay for the detection of androgen agonistic and antagonistic effects. PMID:14644666

  10. Nonsteroidal selective androgen receptor modulators enhance female sexual motivation.

    PubMed

    Jones, Amanda; Hwang, Dong Jin; Duke, Charles B; He, Yali; Siddam, Anjaiah; Miller, Duane D; Dalton, James T

    2010-08-01

    Women experience a decline in estrogen and androgen levels after natural or surgically induced menopause, effects that are associated with a loss of sexual desire and bone mineral density. Studies in our laboratories have shown the beneficial effects of selective androgen receptor modulators (SARMs) in the treatment of osteoporosis and muscle wasting in animal models. A series of S-3-(phenoxy)-2-hydroxy-2-methyl-N-(4-cyano-3-trifluoromethyl-phenyl)-propionamide analogs was synthesized to evaluate the effects of B-ring substitutions on in vitro and in vivo pharmacologic activity, especially female sexual motivation. The androgen receptor (AR) relative binding affinities ranged from 0.1 to 26.5% (relative to dihydrotestosterone) and demonstrated a range of agonist activity at 100 nM. In vivo pharmacologic activity was first assessed by using male rats. Structural modifications to the B-ring significantly affected the selectivity of the SARMs, demonstrating that single-atom substitutions can dramatically and unexpectedly influence activity in androgenic (i.e., prostate) and anabolic (i.e., muscle) tissues. (S)-N-(4-cyano-3-trifluoromethyl-phenyl)-3-(3-fluoro,4-chlorophenoxy)-2-hydroxy-2-methyl-propanamide (S-23) displayed full agonist activity in androgenic and anabolic tissues; however, the remaining SARMs were more prostate-sparing, selectively maintaining the size of the levator ani muscle in castrated rats. The partner-preference paradigm was used to evaluate the effects of SARMs on female sexual motivation. With the exception of two four-halo substituted analogs, the SARMs increased sexual motivation in ovariectomized rats, with potency and efficacy comparable with testosterone propionate. These results indicate that the AR is important in regulating female libido given the nonaromatizable nature of SARMs and it could be a superior alternative to steroidal testosterone preparations in the treatment of hypoactive sexual desire disorder.

  11. A selective androgen receptor modulator for hormonal male contraception.

    PubMed

    Chen, Jiyun; Hwang, Dong Jin; Bohl, Casey E; Miller, Duane D; Dalton, James T

    2005-02-01

    The recent discovery of nonsteroidal selective androgen receptor modulators (SARMs) provides a promising alternative for testosterone replacement therapies, including hormonal male contraception. The identification of an orally bioavailable SARM with the ability to mimic the central and peripheral androgenic and anabolic effects of testosterone would represent an important step toward the "male pill". We characterized the in vitro and in vivo pharmacologic activity of (S)-3-(4-chloro-3-fluorophenoxy)-2-hydroxy-2-methyl-N-(4-nitro-3-trifluoromethylphenyl)propionamide (C-6), a novel SARM developed in our laboratories. C-6 was identified as an androgen receptor (AR) agonist with high AR binding affinity (K(i) = 4.9 nM). C-6 showed tissue-selective pharmacologic activity with higher anabolic activity than androgenic activity in male rats. The doses required to maintain the weight of the prostate, seminal vesicles, and levator ani muscle to half the size of the maximum effects (i.e., ED(50)) were 0.78 +/- 0.06, 0.88 +/- 0.1, and 0.17 +/- 0.04 mg/day, respectively. As opposed to other SARMs, gonadotropin levels in C-6-treated groups were significantly lower than control values. C-6 also significantly decreased serum testosterone concentration in intact rats after 2 weeks of treatment. Marked suppression of spermatogenesis was observed after 10 weeks of treatment with C-6 in intact male rats. Pharmacokinetic studies of C-6 in male rats revealed that C-6 was well absorbed after oral administration (bioavailability 76%), with a long (6.3 h) half-life at a dose of 10 mg/kg. These studies show that C-6 mimicked the in vivo pharmacologic and endocrine effects of testosterone while maintaining the oral bioavailability and tissue-selective actions of nonsteroidal SARMs.

  12. Mechanism of Action of Bolandiol (19-Nortestosterone-3β,17β-Diol), a Unique Anabolic Steroid with Androgenic, Estrogenic, and Progestational Activities*

    PubMed Central

    Attardi, Barbara J.; Page, Stephanie T.; Hild, Sheri A.; Coss, Christopher C.; Matsumoto, Alvin M.

    2009-01-01

    Bolandiol is a synthetic anabolic steroid that increases lean body mass and bone mineral density without significant stimulation of sex accessory glands in castrate adult male rats. Since bolandiol suppresses gonadotropins and endogenous testosterone (T) production, we investigated its mechanism of action. We compared the potency of bolandiol in vitro and in vivo with T, 5α-dihydrotestosterone (DHT), 19-nortestosterone (19-NT) and estradiol (E2). Bolandiol bound with lower affinity to the recombinant rat androgen receptor (AR) than the other androgens and had low, but measurable, affinity for recombinant human progestin receptors (PR-A, PR-B), and estrogen receptors (ERα and β-1). Functional agonist activity was assessed in transcription assays mediated by AR, PR, or ER. Bolandiol was stimulatory in all these assays, but only 4–9% as potent as T, DHT, and 19-NT via AR, 1% as potent as progesterone via PR, and 3% and 1% as potent as E2 acting through ERα or ERβ, respectively. In immature castrate rats, bolandiol was equipotent to T in stimulating growth of the levator ani muscle but less potent than T in stimulating growth of the sex accessory glands. Bolandiol also stimulated uterine weight increases in immature female rats, which were partly blocked by ICI 182,780, but it was not aromatized in vitro by recombinant human aromatase. In contrast to T, stimulation of sex accessory gland weights by bolandiol was not inhibited by concomitant treatment with the dual 5α-reductase inhibitor dutasteride. As bolandiol exhibits tissue selectivity in vivo, it may act via AR, PR, and/or ER, utilize alternative signaling pathway(s) or transcriptional coregulators, and/or be metabolized to a more potent selective steroid. PMID:19941958

  13. Nonsteroidal Selective Androgen Receptor Modulators Enhance Female Sexual Motivation

    PubMed Central

    Jones, Amanda; Hwang, Dong Jin; Duke, Charles B.; He, Yali; Siddam, Anjaiah; Miller, Duane D.

    2010-01-01

    Women experience a decline in estrogen and androgen levels after natural or surgically induced menopause, effects that are associated with a loss of sexual desire and bone mineral density. Studies in our laboratories have shown the beneficial effects of selective androgen receptor modulators (SARMs) in the treatment of osteoporosis and muscle wasting in animal models. A series of S-3-(phenoxy)-2-hydroxy-2-methyl-N-(4-cyano-3-trifluoromethyl-phenyl)-propionamide analogs was synthesized to evaluate the effects of B-ring substitutions on in vitro and in vivo pharmacologic activity, especially female sexual motivation. The androgen receptor (AR) relative binding affinities ranged from 0.1 to 26.5% (relative to dihydrotestosterone) and demonstrated a range of agonist activity at 100 nM. In vivo pharmacologic activity was first assessed by using male rats. Structural modifications to the B-ring significantly affected the selectivity of the SARMs, demonstrating that single-atom substitutions can dramatically and unexpectedly influence activity in androgenic (i.e., prostate) and anabolic (i.e., muscle) tissues. (S)-N-(4-cyano-3-trifluoromethyl-phenyl)-3-(3-fluoro,4-chlorophenoxy)-2-hydroxy-2-methyl-propanamide (S-23) displayed full agonist activity in androgenic and anabolic tissues; however, the remaining SARMs were more prostate-sparing, selectively maintaining the size of the levator ani muscle in castrated rats. The partner-preference paradigm was used to evaluate the effects of SARMs on female sexual motivation. With the exception of two four-halo substituted analogs, the SARMs increased sexual motivation in ovariectomized rats, with potency and efficacy comparable with testosterone propionate. These results indicate that the AR is important in regulating female libido given the nonaromatizable nature of SARMs and it could be a superior alternative to steroidal testosterone preparations in the treatment of hypoactive sexual desire disorder. PMID:20444881

  14. Pharmacological characterization of an imidazolopyrazole as novel selective androgen receptor modulator.

    PubMed

    Zhang, Xuqing; Allan, George F; Tannenbaum, Pamela; Sbriscia, Tifanie; Linton, Olivia; Lai, Muh-Tsann; Haynes-Johnson, Donna; Bhattacharjee, Sheela; Lundeen, Scott G; Sui, Zhihua

    2013-03-01

    Selective androgen receptor modulators (SARMs) are androgens with tissue-selective activity. SARMs that have anabolic activity on muscle while having minimal stimulatory activity on prostate are classified as SARM agonists. They can be used to prevent the loss of lean body mass that is associated with cancer, immunodeficiency, renal disease and aging. They may also have anabolic activity on bone; thus, unlike estrogens, they may reverse the loss of bone strength associated with aging or hypogonadism. Our in-house effort on SARM program discovers a nonsteroidal androgen receptor ligand with a unique imidazolopyrazole moiety in its structure. In vitro, this compound is a weak androgen receptor binder and a weak androgen agonist. Despite this, in orchidectomized mature rats it is an effective SARM agonist, with an ED(50) on levator ani muscle of 3.3mg/kg and an ED(50) on ventral prostate of >30mg/kg. It has its maximal effect on muscle at the dose of 10mg/kg. In addition, this compound has mixed agonistic and antagonistic activities on prostate, reducing the weight of that tissue in intact rats by 22% at 10mg/kg. The compound does not have significant effect on gonadotropin levels or testosterone levels in both orchidectomized and intact male rats. It does not have notable progestin, estrogen or glucocorticoid agonistic or antagonistic activity in rats. In a female sexual behavior model, it improves the sexual desire of ovariectomized female rats for sexually mature intact males over nonsexually ovariectomized females. Overall, the imidazolopyrazole is a potent prostate-sparing candidate for development as a SARM agonist with an appropriate pharmacological profile for clinical benefit in muscle-wasting conditions and female sexual function disorders. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial.

    PubMed

    Zhang, Hufei; Liu, Xinhe; Jiang, Hongye; Liu, Zimeng; Zhang, Xu-Yu; Xie, Hong-Zhe

    2016-01-01

    Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P <0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P <0.001) and the intensity of bilateral shoulder pain (both P <0.01). Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

  16. Effects of oral cimetidine on the reproductive system of male rats

    PubMed Central

    Liu, Xu; Jia, Yuling; Chong, Liming; Jiang, Juan; Yang, Yang; Li, Lei; Ma, Aicui; Sun, Zuyue; Zhou, Li

    2018-01-01

    Cimetidine is widely used for the treatment of digestive tract ulcers, but it induces testis injury. To explore the mechanisms underlying cimetidine-induced toxicity towards the testis, the effects of oral cimetidine on the reproductive system of male rats were assessed. Cimetidine was orally administered to male rats at 20, 40 or 120 mg/kg/day for 9 weeks. The rats were then euthanized, and serum, testis, epididymis, prostate gland, seminal vesicle, preputial gland, levator ani muscle and sphincter ani samples were collected. Sperm parameters were obtained by computer-assisted sperm analysis. Serum hormone levels were measured by ELISA. Protein expression levels were detected by immunohistochemistry. Apoptosis was assessed with the DeadEnd™ Colorimetric Apoptosis Detection System. The results indicated that the sperm average path velocity, straight line velocity and curvilinear velocity were significantly decreased in the 120 mg/kg cimetidine group compared with the control group, while luteinizing hormone and testosterone levels were significantly higher compared with the control group. Testicular lesions were observed by histopathology in the 120 mg/kg cimetidine group. The amounts of cells positive for cyclooxygenase-2 (COX-2) and nuclear factor κB (NF-κB) were increased in the 120 mg/kg cimetidine group compared with the control group. The amounts of cells positive for iNOS were increased in all cimetidine treatment groups. In addition, apoptotic cells were significantly more abundant in the 120 mg/kg cimetidine group compared with the control group, as indicated by terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling. Overall, 9 weeks of oral cimetidine induced pathological changes in the testicles and hormone secretion disorder in rats. COX-2, iNOS and NF-κB upregulation and induction of apoptosis may be associated with the reproductive toxicity caused by cimetidine.

  17. A Comparison of the Need for Speech Therapy After 2 Palatal Repair Techniques.

    PubMed

    Yen, Debra W; Nguyen, Dennis C; Skolnick, Gary B; Naidoo, Sybill D; Patel, Kamlesh B; Grames, Lynn Marty; Woo, Albert S

    2017-03-01

    Reconstruction of the levator musculature during cleft palate repair has been suggested to be important in long-term speech outcomes. In this study, we compare the need for postoperative speech therapy between 2 intravelar veloplasty techniques. Chart review was performed for patients with nonsyndromic cleft palate who underwent either primary Kriens or overlapping intravelar veloplasty before 18 months of age. All subjects completed a follow-up visit at approximately 3 years of age. Data obtained included documentation of ongoing or recommended speech therapy at age 3 years and reasons for speech therapy, which were categorized as cleft-related and non-cleft-related by a speech-language pathologist. One surgeon performed all Kriens procedures (n = 81), and the senior author performed all overlapping procedures (n = 25). Mean age at surgery (Kriens = 13.5 ± 1.4 months; overlapping = 13.1 ± 1.5 months; P = 0.188) and age at 3-year follow-up (Kriens = 3.0 ± 0.5 years; overlapping = 2.8 ± 0.5 years; P = 0.148) were equivalent in both groups. Cleft severity by Veau classification (P = 0.626), prepalatoplasty pure tone averages, (P = 0.237), pure tone averages at 3-year follow-up (P = 0.636), and incidence of prematurity (P = 0.190) were also similar between the 2 groups. At 3 years of age, significantly fewer overlapping intravelar veloplasty patients required cleft-related speech therapy (Kriens = 47%; overlapping = 20%; P = 0.015). The proportions of patients requiring non-cleft-related speech therapy were equivalent (P = 0.906). At 3 years of age, patients who received overlapping intravelar veloplasty were significantly less likely to need cleft-related speech therapy compared with patients who received Kriens intravelar veloplasty. Cleft severity, hearing loss, and prematurity at birth did not appear to explain the difference found in need for speech therapy.

  18. Development of mandibular, hyoid and hypobranchial muscles in the zebrafish: homologies and evolution of these muscles within bony fishes and tetrapods

    PubMed Central

    Diogo, Rui; Hinits, Yaniv; Hughes, Simon M

    2008-01-01

    Background During vertebrate head evolution, muscle changes accompanied radical modification of the skeleton. Recent studies have suggested that muscles and their innervation evolve less rapidly than cartilage. The freshwater teleostean zebrafish (Danio rerio) is the most studied actinopterygian model organism, and is sometimes taken to represent osteichthyans as a whole, which include bony fishes and tetrapods. Most work concerning zebrafish cranial muscles has focused on larval stages. We set out to describe the later development of zebrafish head muscles and compare muscle homologies across the Osteichthyes. Results We describe one new muscle and show that the number of mandibular, hyoid and hypobranchial muscles found in four day-old zebrafish larvae is similar to that found in the adult. However, the overall configuration and/or the number of divisions of these muscles change during development. For example, the undivided adductor mandibulae of early larvae gives rise to the adductor mandibulae sections A0, A1-OST, A2 and Aω, and the protractor hyoideus becomes divided into dorsal and ventral portions in adults. There is not always a correspondence between the ontogeny of these muscles in the zebrafish and their evolution within the Osteichthyes. All of the 13 mandibular, hyoid and hypobranchial muscles present in the adult zebrafish are found in at least some other living teleosts, and all except the protractor hyoideus are found in at least some extant non-teleost actinopterygians. Of these muscles, about a quarter (intermandibularis anterior, adductor mandibulae, sternohyoideus) are found in at least some living tetrapods, and a further quarter (levator arcus palatini, adductor arcus palatini, adductor operculi) in at least some extant sarcopterygian fish. Conclusion Although the zebrafish occupies a rather derived phylogenetic position within actinopterygians and even within teleosts, with respect to the mandibular, hyoid and hypobranchial muscles it

  19. [Relationship between perineal characteristics and symptoms and pelvic girdle pain: A literature review].

    PubMed

    Rejano-Campo, M; Desvergée, A; Pizzoferrato, A C

    2018-03-01

    Pelvic girdle pain (PGP) is characterized by the presence of pain in the posterior pelvic area, distally and laterally to the fifth lumbar vertebra, and/or at the pubic symphysis. PGP is a very common pain condition in women, especially during pregnancy and postpartum. After delivery, pain prevalence decreases to 7 % in the first three months. The current literature describes an association between pelvic girdle pain and different perineal characteristics and symptoms. A better understanding of perineal structures influence on PGP could assist towards the management of this condition. The aim of this review is to describe the peer-reviewed literature about perineal function in patients with PGP. A bibliographic search on PubMed was conducted. The key words used were: pelvic girdle pain, pregnacy-related low back pain, lumbopelvic pain, posterior pelvic pain, peripartum pelvic pain, pelvic girdle relaxation, pelvic joint instability, peripartum pelvic pain, sacroiliac joint pain, sacroiliac joint dysfunction, sacroiliac-joint related pelvic pain and pelvic floor. Two hundred and twenty-one (221) articles were identified. Out of them, a total of nine articles were selected. The level of evidence was determined using Oxford's scale. Patients with PGP showed increased activity of the pelvic floor muscles (P=0.05) (LE3), decreased urogenital hiatus area (PGP 12.4 cm 2 ±2.7, control 13.7 cm 2 ±2.8, P=0.015) (LE3), shorter endurance time (PGP 17.8 s; control 54.0 s, P=0.00) (LE3), significantly later onset time during affected side leg elevation (PGP 25ms, control -129ms, P=0.01) (LE3), levator ani and obturator internus tenderness (PGP 25/26; control 5/25, P<0.001) (LE3) and a higher prevalence of vesico-sphincteric disorders compared to asymptomatic subjects (LE3). This review confirms that subjects suffering PGP present particular perineal characteristics regarding morphology and biomechanics. It would be interesting to develop clinical research concerning

  20. Testosterone Dose Dependently Prevents Bone and Muscle Loss in Rodents after Spinal Cord Injury

    PubMed Central

    Conover, Christine F.; Beggs, Luke A.; Beck, Darren T.; Otzel, Dana M.; Balaez, Alexander; Combs, Sarah M.; Miller, Julie R.; Ye, Fan; Aguirre, J. Ignacio; Neuville, Kathleen G.; Williams, Alyssa A.; Conrad, Bryan P.; Gregory, Chris M.; Wronski, Thomas J.; Bose, Prodip K.; Borst, Stephen E.

    2014-01-01

    Abstract Androgen administration protects against musculoskeletal deficits in models of sex-steroid deficiency and injury/disuse. It remains unknown, however, whether testosterone prevents bone loss accompanying spinal cord injury (SCI), a condition that results in a near universal occurrence of osteoporosis. Our primary purpose was to determine whether testosterone-enanthate (TE) attenuates hindlimb bone loss in a rodent moderate/severe contusion SCI model. Forty (n=10/group), 14 week old male Sprague-Dawley rats were randomized to receive: (1) Sham surgery (T9 laminectomy), (2) moderate/severe (250 kdyne) SCI, (3) SCI+Low-dose TE (2.0 mg/week), or (4) SCI+High-dose TE (7.0 mg/week). Twenty-one days post-injury, SCI animals exhibited a 77–85% reduction in hindlimb cancellous bone volume at the distal femur (measured via μCT) and proximal tibia (measured via histomorphometry), characterized by a >70% reduction in trabecular number, 13–27% reduction in trabecular thickness, and increased trabecular separation. A 57% reduction in cancellous volumetric bone mineral density (vBMD) at the distal femur and a 20% reduction in vBMD at the femoral neck were also observed. TE dose dependently prevented hindlimb bone loss after SCI, with high-dose TE fully preserving cancellous bone structural characteristics and vBMD at all skeletal sites examined. Animals receiving SCI also exhibited a 35% reduction in hindlimb weight bearing (triceps surae) muscle mass and a 22% reduction in sublesional non-weight bearing (levator ani/bulbocavernosus [LABC]) muscle mass, and reduced prostate mass. Both TE doses fully preserved LABC mass, while only high-dose TE ameliorated hindlimb muscle losses. TE also dose dependently increased prostate mass. Our findings provide the first evidence indicating that high-dose TE fully prevents hindlimb cancellous bone loss and concomitantly ameliorates muscle loss after SCI, while low-dose TE produces much less profound musculoskeletal benefit

  1. Two-dimensional analysis of palpebral opening in blepharoptosis: visual iris-pupil complex percentage by digital photography.

    PubMed

    Choi, Yeop; Eo, SuRak

    2014-04-01

    The vertical dimension of the palpebral fissure and the marginal reflex distance are conventionally used to assess the amount or degree of blepharoptosis, and levator function is assessed by measuring total upper lid excursion between the extremes of down-gaze and up-gaze. However, these are 1-dimensional measures obtained with a ruler, and the results obtained are dependent on examiner skill. Digital photographs were obtained of 692 patients before and after upper blepharoplasty. Visual iris-pupil complex percentage (VIP) was measured in the 1,305 eyes by digital calculation using Adobe Photoshop CS3 (Adobe Systems, Inc). Perioperative eye images in primary gaze were evaluated independently by 2 surgeons, 2 nurses, and a graphic designer, and after excluding 50 eyes which were nonconcordant and 29 eyes which revealed retracted upper lids, the remaining 1,305 eyes were classified into 4 major groups, that is, into excellent (n = 415), good (n = 435), subclinical (n = 270), and prominent ptosis (n = 185) groups. In addition, eyes were subdivided into 5 types according to the iris-pupil complex position within the palpebral fissure. Visual iris-pupil complex percentages were from 85% to 94% in the excellent, from 78% to 84% in the good, from 70% to 77% in the subclinical ptosis, and below 70% in the prominent ptosis group. Patients in the subclinical or prominent ptosis eye group required surgery for blepharoptosis. Iris-pupil complex relation to the palpebral opening was classified into 5 eye types, namely, standard (n = 961), scleral (n = 266), sinking (n = 151), retracted (n = 3), and fish (n = 3). The authors devised a new prospective measurement method for assessing blepharoptosis in a clinical setting. Graphical comparisons between the devised method of measuring VIP and mathematical estimations showed that the devised method is easier, more practical, and more precise for measuring degree of blepharoptosis from general population trends, and that VIP also

  2. Noninvasive analysis of human neck muscle function

    NASA Technical Reports Server (NTRS)

    Conley, M. S.; Meyer, R. A.; Bloomberg, J. J.; Feeback, D. L.; Dudley, G. A.

    1995-01-01

    STUDY DESIGN. Muscle use evoked by exercise was determined by quantifying shifts in signal relaxation times of T2-weighted magnetic resonance images. Images were collected at rest and after exercise at each of two intensities (moderate and intense) for each of four head movements: 1) extension, 2) flexion, 3) rotation, and 4) lateral flexion. OBJECTIVE. This study examined the intensity and pattern of neck muscle use evoked by various movements of the head. The results will help elucidate the pathophysiology, and thus methods for treating disorders of the cervical musculoskeletal system. SUMMARY OF BACKGROUND DATA. Exercise-induced contrast shifts in T2 has been shown to indicate muscle use during the activity. The noninvasive nature of magnetic resonance imaging appears to make it an ideal approach for studying the function of the complex neuromuscular system of the neck. METHODS. The extent of T2 increase was examined to gauge how intensely nine different neck muscles or muscle pairs were used in seven subjects. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation was assessed to infer the pattern of use among and within individual neck muscles or muscle pairs. RESULTS. Signal relaxation increased with exercise intensity for each head movement. The absolute and relative cross-sectional area of muscle showing a shift in signal relaxation also increased with exercise load. Neck muscles or muscle pairs extensively used to perform each head movement were: extension--semispinalis capitis and cervicis and splenius capitis; flexion--sternocleidomastoid and longus capitis and colli; rotation--splenius capitis, levator scapulae, scalenus, semispinalis capitis ipsilateral to the rotation, and sternocleidomastoid contralateral; and lateral flexion--sternocleidomastoid CONCLUSION. The results of this study, in part, agree with the purported functions of neck muscles derived from anatomic location. This also was true for the few

  3. Myofascial trigger points, pain, disability, and sleep quality in individuals with mechanical neck pain.

    PubMed

    Muñoz-Muñoz, Sonsoles; Muñoz-García, María T; Alburquerque-Sendín, Francisco; Arroyo-Morales, Manuel; Fernández-de-las-Peñas, César

    2012-10-01

    The purpose of this study was to investigate the presence of active myofascial trigger points (MTrPs) in a greater number of muscles than previous studies and the relation between the presence of MTrPs, the intensity of pain, disability, and sleep quality in mechanical neck pain. Fifteen patients with mechanical neck pain (80% women) and 12 comparable controls participated. Myofascial trigger points were bilaterally explored in the upper trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid, levator scapulae, and scalene muscles in a blinded design. Myofascial trigger points were considered active if the subject recognized the elicited referred pain as a familiar symptom. Myofascial trigger points were considered latent if the elicited referred pain was not recognized as a symptom. Pain was collected with a numerical pain rate scale (0-10); disability was assessed with Neck Disability Index; and sleep quality, with the Pittsburgh Sleep Quality Index. Patients exhibited a greater disability and worse sleep quality than controls (P < .001). The Pittsburgh Sleep Quality Index score was associated with the worst intensity of pain (r = 0.589; P = .021) and disability (r = 0.552; P = .033). Patients showed a greater (P = .002) number of active MTrPs (mean, 2 ± 2) and similar number (P = .505) of latent MTrPs (1.6 ± 1.4) than controls (latent MTrPs, 1.3 ± 1.4). No significant association between the number of latent or active MTrPs and pain, disability, or sleep quality was found. The referred pain elicited by active MTrPs in the neck and shoulder muscles contributed to symptoms in mechanical neck pain. Patients exhibited higher disability and worse sleep quality than controls. Sleep quality was associated with pain intensity and disability. No association between active MTrPs and the intensity of pain, disability, or sleep quality was found. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  4. The interaction between tropomyosin-related kinase B receptors and presynaptic muscarinic receptors modulates transmitter release in adult rodent motor nerve terminals.

    PubMed

    Garcia, Neus; Tomàs, Marta; Santafé, Manel M; Besalduch, Nuria; Lanuza, Maria A; Tomàs, Josep

    2010-12-08

    The neurotrophin brain-derived neurotrophic factor (BDNF), neurotrophin-4 (NT-4) and the receptors tropomyosin-related kinase B (trkB) and p75(NTR) are present in the nerve terminals on the neuromuscular junctions (NMJs) of the levator auris longus muscle of the adult mouse. Exogenously added BDNF or NT-4 increased evoked ACh release after 3 h. This presynaptic effect (the size of the spontaneous potentials is not affected) is specific because it is not produced by neurotrophin-3 (NT-3) and is prevented by preincubation with trkB-IgG chimera or by pharmacological block of trkB [K-252a (C₂₇H₂₁N₃O₅)] or p75(NTR) [Pep5 (C₈₆H₁₁₁N₂₅O₁₉S₂] signaling. The effect of BDNF depends on the M₁ and M₂ muscarinic acetylcholine autoreceptors (mAChRs) because it is prevented by atropine, pirenzepine and methoctramine. We found that K-252a incubation reduces ACh release (~50%) in a short time (1 h), but the p75(NTR) signaling inhibitor Pep5 does not have this effect. The specificity of the K-252a blocking effect on trkB was confirmed with the anti-trkB antibody 47/trkB, which reduces evoked ACh release, like K-252a, whereas the nonpermeant tyrosine kinase blocker K-252b does not. Neither does incubation with the fusion protein trkB-IgG (to chelate endogenous BDNF/NT-4), anti-BDNF or anti-NT-4 change ACh release. Thus, the trkB receptor normally seems to be coupled to ACh release when there is no short-term local effect of neurotrophins at the NMJ. The normal function of the mAChR mechanism is a permissive prerequisite for the trkB pathway to couple to ACh release. Reciprocally, the normal function of trkB modulates M₁- and M₂-subtype muscarinic pathways.

  5. Adenosine A₁ and A₂A receptor-mediated modulation of acetylcholine release in the mice neuromuscular junction.

    PubMed

    Garcia, Neus; Priego, Mercedes; Obis, Teresa; Santafe, Manel M; Tomàs, Marta; Besalduch, Nuria; Lanuza, M Angel; Tomàs, Josep

    2013-07-01

    Immunocytochemistry shows that purinergic receptors (P1Rs) type A1 and A2A (A1 R and A2 A R, respectively) are present in the nerve endings at the P6 and P30 Levator auris longus (LAL) mouse neuromuscular junctions (NMJs). As described elsewhere, 25 μm adenosine reduces (50%) acetylcholine release in high Mg(2+) or d-tubocurarine paralysed muscle. We hypothesize that in more preserved neurotransmission machinery conditions (blocking the voltage-dependent sodium channel of the muscle cells with μ-conotoxin GIIIB) the physiological role of the P1Rs in the NMJ must be better observed. We found that the presence of a non-selective P1R agonist (adenosine) or antagonist (8-SPT) or selective modulators of A1 R or A2 A R subtypes (CCPA and DPCPX, or CGS-21680 and SCH-58261, respectively) does not result in any changes in the evoked release. However, P1Rs seem to be involved in spontaneous release (miniature endplate potentials MEPPs) because MEPP frequency is increased by non-selective block but decreased by non-selective stimulation, with A1 Rs playing the main role. We assayed the role of P1Rs in presynaptic short-term plasticity during imposed synaptic activity (40 Hz for 2 min of supramaximal stimuli). Depression is reduced by micromolar adenosine but increased by blocking P1Rs with 8-SPT. Synaptic depression is not affected by the presence of selective A1 R and A2 A R modulators, which suggests that both receptors need to collaborate. Thus, A1 R and A2 A R might have no real effect on neuromuscular transmission in resting conditions. However, these receptors can conserve resources by limiting spontaneous quantal leak of acetylcholine and may protect synaptic function by reducing the magnitude of depression during repetitive activity. © 2013 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  6. Disability self-assessment and upper quarter muscle balance between female dental hygienists and non-dental hygienists.

    PubMed

    Johnson, Eric G; Godges, Joseph J; Lohman, Everett B; Stephens, Joni A; Zimmerman, Grenith J; Anderson, Sharon P

    2003-01-01

    The purpose of this pilot study was to compare disability self-assessment and upper quarter muscle balance female dental hygienists and non dental hygienist females. The upper quarter was operationally defined as the shoulder and neck region. Muscle balance was operationally defined as muscle flexibility and muscle performance. A convenience sample of 41 working dental hygienists and 46 non dental hygienists participated in the study. Muscle flexibility of the upper quarter was measured by inclinometry or standard muscle length testing. Muscle performance was measured by timing the duration of four statically maintained positions. Subjects filled out the Northwick Park Neck Pain Questionnaire (NPNPQ), which is a disability self-assessment. Analysis of Covariance (ANCOVA) was used during data analysis to adjust for the mean age difference between the dental hygienist group (38.0 years) and the non-dental hygienist group (29.3 years). The results of this pilot study suggest that female dental hygienists are more likely than non dental hygienist females to develop tightness in the upper trapezius (p = 0.007) and the levator scapula (p = 0.01) of the non dominant upper quarter and lower fibers of the pectoralis major of the dominant upper quarter (p = 0.03) Muscle performance trends in the dental hygienist group supported muscle balance theory that short muscles remain strong while lengthened muscles become weak. The dental hygienist group had higher disability scores in all nine parts of the NPNPQ compared to the non-dental hygienist group, five of which were statistically significant (p < 0.05). The results of this pilot study suggest that muscle imbalances in the upper quarter are more common in female dental hygienists than in female non dental hygienists and may contribute to the numerous upper quarter pathologies associated with the practice of dental hygiene. Further research is needed to determine if upper quarter strengthening and flexibility exercises

  7. Amelioration of sexual behavior and motor activity deficits in a castrated rodent model with a selective androgen receptor modulator SARM-2f

    PubMed Central

    Morimoto, Megumi; Amano, Yuichiro; Oka, Masahiro; Harada, Ayako; Fujita, Hisashi; Hikichi, Yukiko; Tozawa, Ryuichi; Yamaoka, Masuo

    2017-01-01

    Sarcopenia and cachexia present characteristic features of a decrease in skeletal muscle mass and strength, anorexia, and lack of motivation. Treatments for these diseases have not yet been established, although selective androgen receptor modulators (SARMs) are considered as therapeutic targets. We previously reported that a novel SARM compound, SARM-2f, exhibits anabolic effect on muscles, with less stimulatory effect on prostate weight compared with testosterone, in rat Hershberger assays and cancer cachexia models. In this study, we studied the mechanism of action for SARM-2f selectivity and also assessed whether the muscle increase by this compound might lead to improvement of muscle function and physical activity. First, we examined the tissue distribution of SARM-2f. Tissue concentration was 1.2-, 1.6-, and 1.9-fold as high as the plasma concentration in the levator ani muscle, brain, and prostate, respectively. This result showed that the tissue-selective pharmacological effect did not depend on SARM-2f concentration in the tissues. The ability of SARM-2f to influence androgen receptor (AR)-mediated transcriptional activation was examined by reporter assays using human normal prostate epithelial cells (PrEC) and skeletal muscle cells (SKMC). SARM-2f exerted higher activity against AR in SKMC than in PrEC. Mammalian two hybrid assays showed different co-factor recruitment patterns between SARM-2f and dihydrotestosterone. Next, we studied the effect of SARM-2f on motivation and physical functions such as sexual behavior and motor activities in castrated rat or mouse models. SARM-2f restored the sexual behavior that was lost by castration in male rats. SARM-2f also increased voluntary running distance and locomotor activities. These results suggest that tissue-specific AR regulation by SARM-2f, but not tissue distribution, might account for its tissue specific androgenic effect, and that the muscle mass increase by SARM-2f leads to improvement of physical

  8. The cat vertebral column: stance configuration and range of motion

    NASA Technical Reports Server (NTRS)

    Macpherson, J. M.; Ye, Y.; Peterson, B. W. (Principal Investigator)

    1998-01-01

    This study examined the configuration of the vertebral column of the cat during independent stance and in various flexed positions. The range of motion in the sagittal plane is similar across most thoracic and lumbar joints, with the exception of a lesser range at the transition region from thoracic-type to lumbar-type vertebrae. The upper thoracic column exhibits most of its range in dorsiflexion and the lower thoracic and lumbar in ventroflexion. Lateral flexion is limited to less than 5 degrees at all segments. The range in torsion is almost 180 degrees and occurs primarily in the midthoracic region, T4-T11. Contrary to the depiction in most atlases, the standing cat exhibits several curvatures, including a mild dorsiflexion in the lower lumbar segments, a marked ventroflexion in the lower thoracic and upper lumbar segments, and a profound dorsiflexion in the upper thoracic (above T9) and cervical segments. The curvatures are not significantly changed by altering stance distance but are affected by head posture. During stance, the top of the scapula lies well above the spines of the thoracic vertebrae, and the glenohumeral joint is just below the bodies of vertebrae T3-T5. Using a simple static model of the vertebral column in the sagittal plane, it was estimated that the bending moment due to gravity is bimodal with a dorsiflexion moment in the lower thoracic and lumbar region and a ventroflexion moment in the upper thoracic and cervical region. Given the bending moments and the position of the scapula during stance, it is proposed that two groups of scapular muscles provide the major antigravity support for the head and anterior trunk. Levator scapulae and serratus ventralis form the lateral group, inserting on the lateral processes of cervical vertebrae and on the ribs. The major and minor rhomboids form the medial group, inserting on the spinous tips of vertebrae from C4 to T4. It is also proposed that the hypaxial muscles, psoas major, minor, and quadratus

  9. Ultrafast MR imaging of the pelvic floor.

    PubMed

    Unterweger, M; Marincek, B; Gottstein-Aalame, N; Debatin, J F; Seifert, B; Ochsenbein-Imhof, N; Perucchini, D; Kubik-Huch, R A

    2001-04-01

    The aim of this study was to compare pelvic floor anatomy and laxity at rest and on straining (Valsalva's maneuver) using dynamic ultrafast MR imaging in women who were continent versus those with stress incontinence differing in obstetric history. Thirty continent women were divided into three equal groups (nulliparous, previous cesarean delivery, previous vaginal delivery) and compared with 10 women with stress-incontinence with a history of at least one vaginal delivery. MR imaging of the pelvic floor at rest and on maximal strain was performed, using axial T2-weighted fast spin-echo images followed by sagittal ultrafast T2-weighted single-shot fast spin-echo sequences. Mean population age (age range, 22-45 years; mean +/- SD, 36 +/- 5.4 years), was similar in the four groups, as was parity in the three parous groups. Mean distances between the bladder floor and pubococcygeal line at rest did not differ between the four groups. On straining, bladder floor descent was 1.1 +/- 0.9, 1.0 +/- 1.1, and 1.9 +/- 0.9 cm in continent nulliparous, cesarean delivery, and vaginal delivery women, respectively, versus 3.2 +/- 1.0 cm in incontinent women (p = 0.0005). Cervical descent was greater in incontinent versus nulliparous women (p = 0.0019). Bladder floor descent was greater in the continent vaginal delivery group than in continent cesarean delivery control patients (p = 0.04). In patients with stress incontinence, symptoms did not correlate with amplitude of descent. The right levator muscle was thinner overall than the left, regardless of frequency direction (p = 0.001). Ultrafast MR imaging using the T2-weighted single-shot fast spin-echo sequence allows dynamic evaluation of the pelvic compartments at maximal strain with no need for contrast medium. Pelvic floor laxity and supporting fascia abnormalities were most common in patients with stress incontinence followed by continent women with a history of vaginal delivery. The results are therefore compatible with the

  10. Are chronic neck pain, scapular dyskinesis and altered scapulothoracic muscle activity interrelated?: A case-control study with surface and fine-wire EMG.

    PubMed

    Castelein, Birgit; Cools, Ann; Parlevliet, Thierry; Cagnie, Barbara

    2016-12-01

    The function of the scapula is important in normal neck function and might be disturbed in patients with neck pain. The surrounding muscular system is important for the function of the scapula. To date, it is not clear if patients with idiopathic neck pain show altered activity of these scapulothoracic muscles. Therefore, the objective of this study was to investigate differences in deeper and superficial lying scapulothoracic muscle activity between patients with idiopathic neck pain and healthy controls during arm elevation, and to identify the influence of scapular dyskinesis on muscle activity. Scapular dyskinesis was rated with the yes/no method. The deeper lying (Levator Scapulae, Pectoralis Minor (Pm) and Rhomboid major) and superficial lying (Trapezius and Serratus Anterior) scapulothoracic muscles' activity was investigated with fine-wire and surface EMG, respectively, in 19 female subjects with idiopathic neck pain (age 28.3±10.1years, average duration of neck pain 45.6±36.3months) and 19 female healthy control subjects (age 29.3±11.7years) while performing scaption and towel wall slide. Possible interactions or differences between subject groups, scapular dyskinesis groups or phases of the task were studied with a linear mixed model. Higher Pm activity during the towel wallslide (p=0.024, mean difference 8.8±3.3% MVIC) was shown in patients with idiopathic neck pain in comparison with healthy controls. For the MT, a significant group∗dyskinesis interaction effect was found during scaption which revealed that patients with neck pain and scapular dyskinesis showed lower Middle Trapezius (MT) activity in comparison with healthy controls with scapular dyskinesis (p=0.029, mean difference 5.1±2.2% MVIC). In the presence of idiopathic neck pain, higher Pm activity during the towel wallslide was found. Patients with neck pain and scapular dyskinesis showed lower MT activity in comparison with healthy controls with scapular dyskinesis during scaption

  11. Correlation Between Echodefecography and 3-Dimensional Vaginal Ultrasonography in the Detection of Perineal Descent in Women With Constipation Symptoms.

    PubMed

    Murad-Regadas, Sthela M; Pinheiro Regadas, Francisco Sergio; Rodrigues, Lusmar V; da Silva Vilarinho, Adjra; Buchen, Guilherme; Borges, Livia Olinda; Veras, Lara B; da Cruz, Mariana Murad

    2016-12-01

    Defecography is an established method of evaluating dynamic anorectal dysfunction, but conventional defecography does not allow for visualization of anatomic structures. The purpose of this study was to describe the use of dynamic 3-dimensional endovaginal ultrasonography for evaluating perineal descent in comparison with echodefecography (3-dimensional anorectal ultrasonography) and to study the relationship between perineal descent and symptoms and anatomic/functional abnormalities of the pelvic floor. This was a prospective study. The study was conducted at a large university tertiary care hospital. Consecutive female patients were eligible if they had pelvic floor dysfunction, obstructed defecation symptoms, and a score >6 on the Cleveland Clinic Florida Constipation Scale. Each patient underwent both echodefecography and dynamic 3-dimensional endovaginal ultrasonography to evaluate posterior pelvic floor dysfunction. Normal perineal descent was defined on echodefecography as puborectalis muscle displacement ≤2.5 cm; excessive perineal descent was defined as displacement >2.5 cm. Of 61 women, 29 (48%) had normal perineal descent; 32 (52%) had excessive perineal descent. Endovaginal ultrasonography identified 27 of the 29 patients in the normal group as having anorectal junction displacement ≤1 cm (mean = 0.6 cm; range, 0.1-1.0 cm) and a mean anorectal junction position of 0.6 cm (range, 0-2.3 cm) above the symphysis pubis during the Valsalva maneuver and correctly identified 30 of the 32 patients in the excessive perineal descent group. The κ statistic showed almost perfect agreement (κ = 0.86) between the 2 methods for categorization into the normal and excessive perineal descent groups. Perineal descent was not related to fecal or urinary incontinence or anatomic and functional factors (sphincter defects, pubovisceral muscle defects, levator hiatus area, grade II or III rectocele, intussusception, or anismus). The study did not include a

  12. [STUDY ON WOUND HEALING AFTER Sommerlad TECHNIQUE REPAIR OF ISOLATED CLEFT PALATE].

    PubMed

    Lu, Yong; Shi, Bing; Wang, Zhiyong; Zhan, Xin

    2014-07-01

    To study the inhibitory effect of Sommerlad technique on the growth of the maxilla by comparing the wound healing between Sommerlad and Von Langenbeck techniques in repair of isolated cleft palate. A retrospective cohort study was conducted on 54 patients with isolated cleft palate who received palatoplasty with levator veli palatini retropositioning according to Sommerlad between June 2005 and August 2011 as trial group; 89 cleft patients received Von Langenbeck technique repair between June 2003 and September 2006 as control group. There was no significant difference in gender and age between 2 groups (P > 0.05). The operation time, intraoperative blood loss, body temperature, and fever were recorded and compared; the wound healing was observed, and the palatal mucosa was graded according to Karsten standard. The operation time of trial group [(72.2 ± 5.5) minutes] was significantly longer than that of control group [(58.1 ± 6.8) minutes] (t = 4.494, P = 0.000); the intraoperative blood loss of trial group [(18.6 ± 6.5) mL] was significantly less than that of control group [(34.2 ± 10.2) mL] (t = 2.447, P = 0.000). Within postoperative 48 hours, the highest body temperature was 36.6-37.6°C (mean, 36.9°C) in trial group, and was 36.8-38.2°C (mean, 37.3°C) in control group; fever occurred in 5 patients (9.3%) of trial group and 21 patients (23.6%) of control group, showing significant difference (χ2 = 4.640, P = 0.030). The patients were followed up 3-18 months (mean, 9 months) in the trial group, and 3-6 years (mean, 4 years) in the control group. Scar was rated as level 0, level 1, and level 2 in 38, 13, and 3 cases of trial group, and in 6, 35, and 48 cases of control group, showing significant difference (Z = -7.785, P = 0.000). The isolated cleft palate repair using Sommerlad technique has the advantages of less injury and less scar tissue, indicating no inhibitory effect on the growth of the maxilla.

  13. Tendon transfer options about the shoulder in patients with brachial plexus injury.

    PubMed

    Elhassan, Bassem; Bishop, Allen T; Hartzler, Robert U; Shin, Alexander Y; Spinner, Robert J

    2012-08-01

    The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with brachial plexus injury and to determine the factors associated with favorable outcomes. Fifty-two patients with traumatic brachial plexus injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 injury, twenty-two had a C5-7 injury, five had a C5-8 injury, and thirteen had a C5-T1 injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Tendon transfers about the shoulder can improve shoulder function in patients with brachial plexus injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder

  14. Presynaptic muscarinic acetylcholine autoreceptors (M1, M2 and M4 subtypes), adenosine receptors (A1 and A2A) and tropomyosin-related kinase B receptor (TrkB) modulate the developmental synapse elimination process at the neuromuscular junction.

    PubMed

    Nadal, Laura; Garcia, Neus; Hurtado, Erica; Simó, Anna; Tomàs, Marta; Lanuza, Maria A; Santafé, Manel; Tomàs, Josep

    2016-06-23

    The development of the nervous system involves an initially exuberant production of neurons that make an excessive number of synaptic contacts. The initial overproduction of synapses promotes connectivity. Hebbian competition between axons with different activities (the least active are punished) leads to the loss of roughly half of the overproduced elements and this refines connectivity and increases specificity. The neuromuscular junction is innervated by a single axon at the end of the synapse elimination process and, because of its relative simplicity, has long been used as a model for studying the general principles of synapse development. The involvement of the presynaptic muscarinic ACh autoreceptors may allow for the direct competitive interaction between nerve endings through differential activity-dependent acetylcholine release in the synaptic cleft. Then, the most active ending may directly punish the less active ones. Our previous results indicate the existence in the weakest axons on the polyinnervated neonatal NMJ of an ACh release inhibition mechanism based on mAChR coupled to protein kinase C and voltage-dependent calcium channels. We suggest that this mechanism plays a role in the elimination of redundant neonatal synapses. Here we used confocal microscopy and quantitative morphological analysis to count the number of brightly fluorescent axons per endplate in P7, P9 and P15 transgenic B6.Cg-Tg (Thy1-YFP)16 Jrs/J mice. We investigate the involvement of individual mAChR M1-, M2- and M4-subtypes in the control of axonal elimination after the Levator auris longus muscle had been exposed to agonist and antagonist in vivo. We also analysed the role of adenosine receptor subtypes (A1 and A2A) and the tropomyosin-related kinase B receptor. The data show that postnatal axonal elimination is a regulated multireceptor mechanism that guaranteed the monoinnervation of the neuromuscular synapses. The three receptor sets considered (mAChR, AR and TrkB receptors

  15. Synergistic Action of Presynaptic Muscarinic Acetylcholine Receptors and Adenosine Receptors in Developmental Axonal Competition at the Neuromuscular Junction.

    PubMed

    Nadal, Laura; Garcia, Neus; Hurtado, Erica; Simó, Anna; Tomàs, Marta; Lanuza, Maria Angel; Cilleros, Victor; Tomàs, Josep Maria

    2016-01-01

    The development of the nervous system involves the initial overproduction of synapses, which promotes connectivity. Hebbian competition between axons with different activities leads to the loss of roughly half of the overproduced elements and this refines connectivity. We used quantitative immunohistochemistry to investigate, in the postnatal day 7 (P7) to P9 neuromuscular junctions, the involvement of muscarinic receptors (muscarinic acetylcholine autoreceptors and the M1, M2, and M4 subtypes) and adenosine receptors (A1 and A2A subtypes) in the control of axonal elimination after the mouse levator auris longus muscle had been exposed to selective antagonists in vivo. In a previous study we analyzed the role of each of the individual receptors. Here we investigate the additive or occlusive effects of their inhibitors and thus the existence of synergistic activity between the receptors. The main results show that the A2A, M1, M4, and A1 receptors (in this order of ability) delayed axonal elimination at P7. M4 produces some occlusion of the M1 pathway and some addition to the A1 pathway, which suggests that they cooperate. M2 receptors may modulate (by allowing a permissive action) the other receptors, mainly M4 and A1. The continued action of these receptors (now including M2 but not M4) finally promotes axonal loss at P9. All 4 receptors (M2, M1, A1, and A2A, in this order of ability) are necessary. The M4 receptor (which in itself does not affect axon loss) seems to modulate the other receptors. We found a synergistic action between the M1, A1, and A2A receptors, which show an additive effect, whereas the potent M2 effect is largely independent of the other receptors (though can be modulated by M4). At P9, there is a full mutual dependence between the A1 and A2A receptors in regulating axon loss. In summary, postnatal axonal elimination is a regulated multireceptor mechanism that involves the cooperation of several muscarinic and adenosine receptor subtypes.

  16. PHYSICAL ACTIVITY AND THE PELVIC FLOOR

    PubMed Central

    Nygaard, Ingrid E.; Shaw, Janet M.

    2015-01-01

    , future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods. PMID:26348380

  17. Ocular Manifestations of Noonan Syndrome: A Prospective Clinical and Genetic Study of 25 Patients.

    PubMed

    van Trier, Dorothée C; Vos, Anna M C; Draaijer, Renske W; van der Burgt, Ineke; Draaisma, Jos M Th; Cruysberg, Johannes R M

    2016-10-01

    To determine the full spectrum of ocular manifestations in patients with Noonan syndrome (NS). Prospective cross-sectional clinical and genetic study in a tertiary referral center. Twenty-five patients with NS (mean age, 14 years; range, 8 months-25 years) clinically diagnosed by validated criteria. All patients were examined by the same team following a detailed study protocol. Genetic analyses were performed in 23 patients. Ocular abnormalities of vision and refraction, external ocular features, ocular position and motility, anterior segment, posterior segment, and intraocular pressure. Ocular features of vision and refraction were amblyopia (32%), myopia (40%), and astigmatism (52%). External ocular features were epicanthic folds (84%), hypertelorism (68%), ptosis (56%), high upper eyelid crease (64%), lower eyelid retraction (60%), abnormal upward slanting palpebral fissures (36%), downward slanting palpebral fissures (32%), and lagophthalmos (28%). Orthoptic abnormalities included strabismus (40%), abnormal stereopsis (44%), and limited ocular motility (40%). Anterior segment abnormalities included prominent corneal nerves (72%) and posterior embryotoxon (32%). Additional ocular features were found, including nonglaucomatous optic disc excavation (20%), relatively low (<10 mmHg) intraocular pressure (22%), and optic nerve hypoplasia (4%). Mutations were established in 22 patients: 19 PTPN11 mutations (76%), 1 SOS1 mutation, 1 BRAF mutation, and 1 KRAS mutation. The patient with the highest number of prominent corneal nerves had an SOS1 mutation. The patient with the lowest visual acuity, associated with bilateral optic nerve hypoplasia, had a BRAF mutation. Patients with severe ptosis and nearly total absence of levator muscle function had PTPN11 mutations. All patients showed at least 3 ocular features (range, 3-13; mean, 7), including at least 1 external ocular feature in more than 95% of the patients. Noonan syndrome is a clinical diagnosis with multiple

  18. Novel, non-steroidal, selective androgen receptor modulators (SARMs) with anabolic activity in bone and muscle and improved safety profile.

    PubMed

    Rosen, J; Negro-Vilar, A

    2002-03-01

    A novel approach to the treatment of osteoporosis in men, and possibly women, is the development of selective androgen receptor modulators (SARMs) that can stimulate formation of new bone with substantially diminished proliferative activity in the prostate, as well as reduced virilizing activity in women. Over the last several years, we have developed a program to discover and develop novel, non-steroidal, orally-active selective androgen receptor modulators (SARMs) that provide improved therapeutic benefits and reduce risk and side effects. In recent studies, we have used a skeletally mature orchiectomized (ORX) male rat as an animal model of male hypogonadism for assessing the efficacy of LGD2226, a nonsteroidal, non-aromatizable, and non-5alpha-reducible SARM. We assessed the activity of LGD2226 on bone turnover, bone mass and bone strength, and also evaluated the effects exerted on classic androgen-dependent targets, such as prostate, seminal vesicles and muscle. A substantial loss of bone density was observed in ORX animals, and this loss was prevented by SARMs, as well as standard androgens. Biochemical markers of bone turnover revealed an early increase of bone resorption in androgen-deficient rats that was repressed in ORX animals treated with the oral SARM, LGD2226, during a 4-month treatment period. Differences in architectural properties and bone strength were detected by histomorphometric and mechanical analyses, demonstrating beneficial effects of LGD2226 on bone quality in androgen-deficient rats. Histomorphometric analysis of cortical bone revealed distinct anabolic activity of LGD2226 in periosteal bone. LGD2226 was able to prevent bone loss and maintain bone quality in ORX rats by stimulating bone formation, while also inhibiting bone turnover. LGD2226 also exerted anabolic activity on the levator ani muscle. Taken together, these results suggest that orally-active, non-steroidal SARMs may be useful therapeutics for both muscle and bone in elderly

  19. Physical activity and the pelvic floor.

    PubMed

    Nygaard, Ingrid E; Shaw, Janet M

    2016-02-01

    women. However, future research is needed to fill the many gaps in our knowledge. Prospective studies are needed in all populations, including potentially vulnerable women, such as those with high genetic risk, levator ani muscle injury, or asymptomatic pelvic organ prolapse, and on women during potentially vulnerable life periods, such as the early postpartum or postoperative periods. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial

    PubMed Central

    Bablis, Peter; Pollard, Henry; Bonello, Rod

    2008-01-01

    Background Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. The control group received a sham NET protocol. Outcome measurements included pain assessment utilizing a visual analog scale and a pressure gauge algometer. Pain sensitivity was measured at four trigger point locations: suboccipital region (S); levator scapulae region (LS); sternocleidomastoid region (SCM) and temporomandibular region (TMJ). For each outcome measurement and each trigger point, we calculated the change in measurement between pre- and post- treatment. We then examined the relationships between these measurement changes and six independent variables (i.e. treatment group and the above five additional participant variables) using forward stepwise General Linear Model. Results The visual analog scale (0 to 10) had an improvement of 7.6 at S, 7.2 at LS, 7.5 at SCM and 7.1 at the TMJ in the treatment group compared with no improvement of at S, and an improvement of 0.04 at LS, 0.1 at SCM and 0.1 at the TMJ point in the control group, (P < 0.001). Conclusion After a short course of NET treatment, measurements of visual analog scale and pressure algometer recordings of four trigger point locations in a cohort of chronic neck pain sufferers were significantly improved when

  1. Anthropometry of eyelid and orbit in four southern Thailand ethnic groups.

    PubMed

    Preechawai, Passorn

    2011-02-01

    To study the basic eyelid and orbital measurement in the four main ethnic groups of southern Thailand. The basic eyelid and orbital surface anatomy of 101 normal subjects aged 20-40 years old were measured in the four ethnic groups of which the majority of people in southern Thailand belong to: Thai, Chinese, Thai-Malay, and Thai-Chinese. Of the 101 subjects, 51 were male and 50 were female. Each ethnic group had at least 12 normal subjects. Male-female data were analyzed separately and compared between groups. The palpebral fissure heights in Thai, Chinese, Thai-Malay, and Thai-Chinese males were 9.5, 9.0, 10.2 and 9.6 mm respectively, which demonstrated statistically significant differences between Thai-Malay versus Thai, and Thai-Malay versus Chinese. The palpebral fissure lengths were 30.4, 29.8, 30.5 and 30.5 mm, but without statistically significant differences. The marginal reflex distances were 3.2, 2.8, 3.7 and 3.1 mm respectively with a statistically significant difference only between Thai-Malay versus Chinese. The levator functions were 15.2, 15.2, 15.3 and 15.2 mm. The upper lid creases were 7.1, 4.0, 6.6, and 4.4 mm, statistically significantly different in Thai versus Chinese, Thai versus Thai-Chinese and Chinese versus Thai-Malay. The Hertel exophthalmometer measurements were 15.4, 16.3, 16.6 and 15.9 mm without statistically significant differences. The female measurements were overall similar to the male measurements, with some parallel differences between the groups. The eyebrow position in this age group was mostly at and above the orbital rim in both genders and all ethnic groups. An absence of upper lid crease and an epicanthal fold were found in significantly greater numbers in the Chinese group compared to the others, while parallel lid crease was significantly found in greater numbers in the Thai-Malay group than in the others. Different eyelid characteristics in diferent ethnic groups are an important feature to note when planning for

  2. [Evaluation of transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction].

    PubMed

    Zhong, X L; Song, J; Xu, Y L; Lyu, X L; Zhong, X H; Wang, A P; Song, Y F

    2017-09-25

    Objective: To evaluate transperineal sonography for lower urinary tract symptoms after pelvic floor reconstruction. Methods: Eighty-three patients with severe pelvic organ prolapse received surgeries in Fuzhou General Hospital from September 2014 to September 2015, dividing into two groups: 27 patients were selected to receive transvaginal mesh (TVM) pelvic floor reconstruction surgery with tension-free vaginal tape-Abbrevo (TVT-Abbrevo) incontinence surgery, named TVM+TVT-Abbrevo group; 56 patients were selected to receive TVM pelvic floor reconstruction surgery only, named TVM group. The ultrasonic parameters at rest, on contraction and Valsalva condition respectively were observed and measured, including the bladder neck descent (BND), urethral rotation angle, retrovesical angle, levator urethra gap (LUG), the existence of bladder neck funneling, position of the tape, by using 2D and 3D transperineal ultrasound. Results: The two groups were compared with the ultrasonic parameters before and after operation: two groups of patients with postoperative BND [(2.3±0.5) versus (3.1±0.7) cm, (1.6±0.4) versus (3.6±0.4) cm] were significantly reduced, the difference was statistically significant ( P= 0.02, P< 0.01). The two groups of LUG before and after operation [(3.62±0.45) versus (3.26±0.92) cm, (2.96±0.47) versus (2.72±0.38) cm] both had significant difference by maximum Valsalva ( P< 0.01, P= 0.04). There was statistical significance difference of urethral rotation angle in TVM+TVT-Abbrevo group by maximum Valsalva ( P= 0.01). Observation of morphology: (1) 2 patients with difficulty in urination in TVM+TVT-Abbrevo group, ultrasound showed when the position of the bladder down the urethra discount; 4 patients with stress urinary incontinence (SUI), ultrasound showed slings off or release. (2) One patient with difficulty in urination in TVM group, but ultrasound showed lower urinary tract anatomy were normal; 5 patients with SUI, ultrasound showed the

  3. Sulfide-Sulfate Mineralizations in Verzino Area (Crotone Basin, Southern Italy): New insights on localized hydrothermal fluid circulations and their relationship with tectonics.

    NASA Astrophysics Data System (ADS)

    Berardi, Gabriele; Lucci, Federico; Cozzupoli, Domenico; Pizzino, Luca; Cantucci, Barbara; Quattrocchi, Fedora

    2010-05-01

    In this early stage of the work we present a preliminary study of hydrothermal mineralizations found in Verzino locality, Crotone Basin, Southern Appennines, (Calabria, Italy). Both geochemical and petrographic investigations were developed with the aim of understanding the genesis of the sulfide-sulfate associations present in the "Argille Marnose del Ponda" formation, deepening their relationship with fluids circulation. These mineralizations have been recognized only in two "Calanchi" morphostructures - Badlands like morphology developed by the differential erosional pattern of the "Argille Marnose del Ponda" fm. - and constituting the northwestern flank of a little valley evolved in the Miocene sedimentary sequence from "Conglomerato di S.Nicola" fm. to "Evaporiti Superiori" fm. The mineralizations are distributed along isooriented centimetric veins (with mean direction of N120) and in nodules diffused close to the veins. These hydrothermal mineralizations are constituted by an associations of Pyrite spherical nodules (millimetric to centimetric in radius with occurrences of well developed octahedral habit single crystals), sulphate crystals (Gypsum, Jarosite, NatroJarosite), Oxides (Goethite mainly), millimetric veins of Barite and micrometric Ankerite specimens. The data (mineral habits, semiquantitative compositions and x-Ray spectra), obtained by an integration of S.E.M and XRD investigations, permit us, at the current stage of the study, to hypothesize a possible hydrothermal origin (whose temperature range estimate needs further investigations) for the sulfide-sulfate mineral phases. At the moment, we exclude their primary or secondary sedimentary provenance. The comparison of our results with the previous scientific literature focused on hydrothermal sulfide-sulfate systems (Vinogradov and Stephanov, 1964; Kostov, 1968; Plummer 1971; Boles, 1978; Ferrini and Moretti 1998) allows us to propose a possible "thermal window" ranging in the interval 50°C-230

  4. Kinematics of walking in the hermit crab, Pagurus pollicarus.

    PubMed

    Chapple, William

    2012-03-01

    Hermit crabs are decapod crustaceans that have adapted to life in gastropod shells. Among their adaptations are modifications to their thoracic appendages or pereopods. The 4th and 5th pairs are adapted for shell support; walking is performed with the 2nd and 3rd pereopods, with an alternation of diagonal pairs. During stance, the walking legs are rotated backwards in the pitch plane. Two patterns of walking were studied to compare them with walking patterns described for other decapods, a lateral gait, similar to that in many brachyurans, and a forward gait resembling macruran walking. Video sequences of free walking and restrained animals were used to obtain leg segment positions from which joint angles were calculated. Leading legs in a lateral walk generated a power stroke by flexion of MC and PD joints; CB angles often did not change during slow walks. Trailing legs exhibited extension of MC and PD with a slight levation of CB. The two joints, B/IM and CP, are aligned at 90° angles to CB, MC and PD, moving dorso-anteriorly during swing and ventro-posteriorly during stance. A forward step was more complex; during swing the leg was rotated forward (yaw) and vertically (pitch), due to the action of TC. At the beginning of stance, TC started to rotate posteriorly and laterally, CB was depressed, and MC flexed. As stance progressed and the leg was directed laterally, PD and MC extended, so that at the end of stance the dactyl tip was quite posterior. During walks of the animal out of its shell, the legs were extended more anterior-laterally and the animal often toppled over, indicating that during walking in a shell its weight stabilized the animal. An open chain kinematic model in which each segment was approximated as a rectangular solid, the dimensions of which were derived from measurements on animals, was developed to estimate the CM of the animal under different load conditions. CM was normally quite anterior; removal of the chelipeds shifted it caudally

  5. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia.

    PubMed

    Yong, Paul J; Williams, Christina; Yosef, Ali; Wong, Fontayne; Bedaiwy, Mohamed A; Lisonkova, Sarka; Allaire, Catherine

    2017-09-01

    Deep dyspareunia negatively affects women's sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive-age women; however, other factors are less clear in this population. To identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive-age women at a referral center. This study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and/or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site. Severity of deep dyspareunia on a numeric pain rating scale of 0 to 10. Severity of deep dyspareunia (scale = 0-10) was independently associated with tenderness of the bladder (b = 0.88, P = .018), pelvic floor (levator ani) (b = 0.66, P = .038), cervix and uterus (b = 0.88, P = .008), and cul-de-sac or uterosacral ligaments (b = 1.39, P < .001), but not with the adnexa (b = -0.16, P = 0.87). The number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r = 0.34, P < .001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b = 1.05, P = .008) and pelvic floor (b = 1.07, P < .001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b = 2.24, P = .001

  6. [Postpartum pelvic floor muscle training and abdominal rehabilitation: Guidelines].

    PubMed

    Deffieux, X; Vieillefosse, S; Billecocq, S; Battut, A; Nizard, J; Coulm, B; Thubert, T

    2015-12-01

    Provide guidelines for clinical practice concerning postpartum rehabilitation. Systematically review of the literature concerning postpartum pelvic floor muscle training and abdominal rehabilitation. Pelvic-floor rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. At least 3 guided sessions with a therapist is recommended, associated with pelvic floor muscle exercises at home. This postpartum rehabilitation improves short-term urinary incontinence (1 year) but not long-term (6-12 years). Early pelvic-floor rehabilitation (within 2 months following childbirth) is not recommended (grade C). Postpartum pelvic-floor rehabilitation in women presenting with anal incontinence, is associated with a lower prevalence of anal incontinence symptoms in short-term (1 year) (EL3) but not long-term (6 and 12) (EL3). Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C) but results are not maintained in medium or long term. No randomized trials have evaluated the pelvic-floor rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long term. It is therefore not recommended (expert consensus). Rehabilitation supervised by a therapist (physiotherapist or midwife) is not associated with better results than simple advice for voluntary contraction of the pelvic floor muscles to prevent/correct, in short term (6 months), a persistent prolapse 6 weeks postpartum (EL2), whether or not with a levator ani avulsion (EL3). Postpartum pelvic-floor rehabilitation is not associated with a decrease in the prevalence of dyspareunia at 1-year follow-up (EL3). Postpartum pelvic-floor rehabilitation guided by a therapist is therefore not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). No randomized trials have evaluated the effect of pelvic

  7. Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries

    PubMed Central

    Xiaoqiang, Li; Xuerong, Zhang; Juan, Liu; Mathew, Bechu Shelley; Xiaorong, Yin; Qin, Wan; Lili, Luo; Yingying, Zhu; Jun, Luo

    2017-01-01

    incidence of moderate to severe CRBD in pudendal group at 30 minutes (29% vs 57%, P < .001), 2 hours (22% vs 55%, P < .000), 8 hours (8% vs 27%, P = .001) and 12 hours (6% vs 16%, P = .035) postoperatively. The postoperative pain score in pudendal group was lower at 30 minutes (P = .003), 2 hours (P < .001), 8 hours (P < .001), and 12 hours (P < .001), with lower heart rate and mean blood pressure. One patient complained about weakness in levator ani muscle. Conclusion: General anesthesia along with bilateral pudendal nerve block decreased the incidence and severity of CRBD for the first 12 hours postoperatively. PMID:29245259

  8. Efficacy of pudendal nerve block for alleviation of catheter-related bladder discomfort in male patients undergoing lower urinary tract surgeries: A randomized, controlled, double-blind trial.

    PubMed

    Xiaoqiang, Li; Xuerong, Zhang; Juan, Liu; Mathew, Bechu Shelley; Xiaorong, Yin; Qin, Wan; Lili, Luo; Yingying, Zhu; Jun, Luo

    2017-12-01

    % vs 55%, P < .000), 8 hours (8% vs 27%, P = .001) and 12 hours (6% vs 16%, P = .035) postoperatively. The postoperative pain score in pudendal group was lower at 30 minutes (P = .003), 2 hours (P < .001), 8 hours (P < .001), and 12 hours (P < .001), with lower heart rate and mean blood pressure. One patient complained about weakness in levator ani muscle. General anesthesia along with bilateral pudendal nerve block decreased the incidence and severity of CRBD for the first 12 hours postoperatively.

  9. Characteristics of work actions of shoe manufacturing assembly line workers and a cross-sectional factor-control study on occupational cervicobrachial disorders.

    PubMed

    Amano, M; Umeda, G; Nakajima, H; Yatsuki, K

    1988-01-01

    The characteristic work actions of female shoe manufacturing assembly line workers were analyzed by the records of 8-mm cine-films. The relationship between cervicobrachial disorders and work actions was investigated as a cross-sectional factor control study by using sex-age matched pairs for non-assembly line workers (102 pairs). The following conclusions were obtained: 1) The assembly line workers handled about 3,400 sneaker shoes per day on the assembly line. A completed shoe weighed 200-500 g. The metal last weighted 400-1,200 g. As the lines were not completely mechanized, the workers passed shoes to the next worker by hand. 2) In the line selected for the study of work actions, 28 female workers and one male worker were engaged. The work direction of the line was one-way (from left to right or vice versa). The actions of the workers were classified into four fundamental actions: i) grasping the shoe or tool, ii) extending or iii) bending of the arms, and iv) keeping the arms in a certain position. These fundamental actions were repeated more than 3,400 times per day by each worker. The time spent in holding a shoe in the left hand was longer than that of the right hand in holding a shoe or tool. 3) Results of medical examinations showed a higher prevalence in assembly line workers than that in non-assembly line workers. Especially the prevalence rate of tapping test, pain sensibility test, vibratory sensibility test, Morley's test, tenosynovitis in the fingers, tenderness at spinal muscle around the thoracic vertebrae, levator muscle of scapula, trapezius muscle, rhomboid muscle, infraspinatus muscle, greater pectoral muscle, anterior scalene muscle, thenar eminence, biceps muscle of arm, brachioradial muscle, and antebrachial flexor muscle were found to be different significantly by McNemar's test between the two groups. These disorders were appeared in the left shoulder, arm and hand. 4) As the non-assembly line workers were not engaged in compulsory work

  10. PubMed Central

    LABBÈ, D.; BUSSU, F.; IODICE, A.

    2012-01-01

    comprehensive treatment of the paralysis, the eyelids are usually managed by Paul Tessier's technique to lengthen the levator muscle of the upper eyelid by aponeurosis interposition, combined with external blepharorrhaphy with Krastinova-Lolov's technique. Facial reanimation using lengthening temporalis myoplasty is a dynamic procedure that has its roots in the techniques of Gillies and McLaughlin. This method is a true lengthening myoplasty procedure using no intermediate grafts. In general, the results with a 1-stage combination of lengthening temporalis myoplasty and static correction of the lagophthalmos appear comparable with the major series in the literature using free microneurovascular transfers combined with cross-facial nerve grafts for longstanding peripheral monolateral facial paralysis. The obvious advantages of temporalis elongation myoplasty consist in its technical ease, a single step, low incidence of complications and markedly reduced operating time. PMID:22767978

  11. A comprehensive approach to long-standing facial paralysis based on lengthening temporalis myoplasty.

    PubMed

    Labbè, D; Bussu, F; Iodice, A

    2012-06-01

    treatment of the paralysis, the eyelids are usually managed by Paul Tessier's technique to lengthen the levator muscle of the upper eyelid by aponeurosis interposition, combined with external blepharorrhaphy with Krastinova-Lolov's technique. Facial reanimation using lengthening temporalis myoplasty is a dynamic procedure that has its roots in the techniques of Gillies and McLaughlin. This method is a true lengthening myoplasty procedure using no intermediate grafts. In general, the results with a 1-stage combination of lengthening temporalis myoplasty and static correction of the lagophthalmos appear comparable with the major series in the literature using free microneurovascular transfers combined with cross-facial nerve grafts for longstanding peripheral monolateral facial paralysis. The obvious advantages of temporalis elongation myoplasty consist in its technical ease, a single step, low incidence of complications and markedly reduced operating time.

  12. Comparison of anti-androgenic activity of flutamide, vinclozolin, procymidone, linuron, and p, p'-DDE in rodent 10-day Hershberger assay.

    PubMed

    Kang, Il Hyun; Kim, Hyung Sik; Shin, Jae-Ho; Kim, Tae Sung; Moon, Hyun Ju; Kim, In Young; Choi, Kwang Sik; Kil, Kwang Sup; Park, Young In; Dong, Mi Sook; Han, Soon Young

    2004-07-01

    The rodent Hershberger assay proposed by the Organization for Economic Co-operation and Development (OECD) is in the process of the validating a test method to detecting the androgenic or anti-androgenic compounds. The aim of this study was to compare the anti-androgenic properties of flutamide, vinclozolin, procymidone, linuron, and p,p'-DDE in a 10-day Hershberger assay. In the present study, we used immature Sprague-Dawley male rats castrated at 6 weeks of age. Testosterone propionate (TP) was subcutaneously injected for 10 consecutive days at doses of 0.1, 0.2, 0.4, 0.8, or 1.6 mg/kg per day. To compare the anti-androgenic activity of test compounds, flutamide (1, 5, 10, or 20 mg/kg per day), a pure androgen antagonist was used as a positive control, and administered by oral gavage after TP (0.4 mg/kg per day) treatment. In addition, vinclozolin (25, 50, or 100 mg/kg per day), procymidone (25, 50, or 100 mg/kg per day), linuron (25, 50, or 100 mg/kg per day), and p,p '-DDE (25, 50, or 100 mg/kg per day) were also administered by oral gavage after TP (0.4 mg/kg per day) treatment. As expected, TP dose-dependently increased accessory sex organ weights, and statistically significant effects were observed at doses of 0.1 (only seminal vesicles) or 0.2mg/kg per day and above. Serum testosterone levels increased significantly at 0.4 mg/kg per day and above, while serum LH levels were decreased in a dose-dependent manner. Flutamide significantly inhibited the TP-induced re-growth of seminal vesicles, ventral prostate, and Levator ani plus bulbocavernosus muscles (LABC) at 1mg/kg per day and above, and Cowper's glands and glans penis at 5mg/kg per day and above. In contrast to accessory sex organ weights, flutamide did not affect the serum testosterone levels compared to the control at any concentration, but serum LH levels were significantly increased at doses of 10 and 20 mg/kg per day. Similar to flutamide, vinclozolin caused a statistically significant decrease in

  13. [Precise application of Traditional Chinese Medicine in minimally-invasive techniques].

    PubMed

    Dong, Fu-Hui

    2018-06-25

    many kinds of disease. To ensure its safety, organization, progressive development, practitioners are trained systematically and manage their treatment approach through disease hierarchy. Moreover, this technique should be conducted according to its technical difficulty, operating conditions, and expertise of the practitioner. The application of minimally invasive techniques of traditional Chinese medicine does not depend on the hospitals' administration system or the regulatory college of medical professionals. The minimally invasive techniques of TCM should be taught from easy to difficult, simple to complicated, and requires gradual progression by the practitioners. Eventually, the minimally invasive techniques of TCM's diagnostic and treatment protocol can be created. These protocols are currently available for reference: ¹Forming diagnosis and differential diagnosis for the conditions below requires expert diagnostic and application skills: cerebral palsy; cervical vertigo; cervical headache; cervical precordial pain; other spine-related diseases. ²The requirements for the diagnosis and differential diagnosis of such techniques are relatively high, and special training is required for the practitioner who performs this technique. The conditions below uses minimally invasive orthopedic surgery and dissection: scar contracture deformity; congenital developmental malformations; cervical Bi -syndrome; shoulder pain syndrome; knee Bi -syndrome; low back pain; cervical spondylosis; lumbar disc herniation; avascular necrosis of the femoral head; ankylosing spondylitis. ³There are no special requirements for the diagnosis and differential diagnosis of such techniques, and special training is required for the practitioner who performs this technique. The technical content is mainly decompression and scar tissue release. a)Muscle strain diseases: levator scapulae, splenius capitis, splenius cervicis, supraspinatus, infraspinatus, teres minor, teres major, serratus